European journal of case reports in internal medicine最新文献

{"title":"A 24-Year-Old Man with Disseminated Tuberculosis and A Corticosteroid-Refractory Paradoxical Reaction to Anti-Tuberculous Treatment.","authors":"Charalampos Charalampidis, Valentina Karantana, Dimitra Kavatha, Sotirios Tsiodras, Konstantinos Thomas","doi":"10.12890/2026_006001","DOIUrl":"10.12890/2026_006001","url":null,"abstract":"<p><strong>Introduction: </strong>Paradoxical reactions during anti-tuberculosis treatment are immune-mediated reactions that complicate treatment even in immunocompetent patients.</p><p><strong>Case description: </strong>We present the case of a previously healthy 24-year-old man with disseminated tuberculosis, who experienced persistent fever, weight loss, and radiological deterioration despite appropriate treatment. These findings were consistent with a paradoxical reaction to treatment, after extensive work-up excluded treatment failure, co-infections, and systemic inflammatory conditions. However, high-dose corticosteroids failed to achieve improvement. Ultimately, an interleukin-1 receptor antagonist (anakinra) was initiated as a salvage therapy for this corticosteroid-refractory paradoxical reaction, resulting in rapid defervescence, normalization of inflammatory markers, and radiological improvement.</p><p><strong>Conclusion: </strong>This case underscores the diagnostic and therapeutic challenges when managing severe reactions in tuberculosis patients, while highlighting the importance of biologics like anakinra in corticosteroid-refractory paradoxical reactions.</p><p><strong>Learning points: </strong>Paradoxical reactions to anti-tuberculosis treatment remain an overlooked cause of non-resolving fever in immunocompetent and immunocompromised patients with tuberculosis and should be considered after ruling out treatment-refractory or complicated infection in persistently febrile patients.Prompt treatment of severe reactions prevents major complications and improves clinical outcomes.Corticosteroid-refractory paradoxical reactions illustrate the potential role of biologics, such as tumour necrosis factor inhibitors and, in our case, interleukin-1 receptor antagonists, in controlling excessive inflammation in tuberculosis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"006001"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469646","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 Cholestatic Jaundice as the Initial Manifestation of Radiologically Occult Metastatic Prostate Cancer: An Icteric Variant of Stauffer Syndrome.","authors":"Mariana Santa Barbara Medeiros, Adriana Rassilan Vilanova, Laura Caroline Führ, Maria Luiza Assunção Azevedo","doi":"10.12890/2026_006232","DOIUrl":"10.12890/2026_006232","url":null,"abstract":"<p><p>Stauffer syndrome is a rare paraneoplastic hepatic dysfunction classically associated with renal cell carcinoma and increasingly recognised in association with other malignancies. The icteric variant, characterised by clinically apparent jaundice and marked hyperbilirubinaemia, is particularly uncommon. We report the case of a 75-year-old man who presented with progressive cholestatic jaundice, with total bilirubin levels peaking at approximately 20 mg/dl. An extensive diagnostic workup including laboratory testing, upper gastrointestinal endoscopy, cross-sectional imaging, magnetic resonance cholangiopancreatography and liver biopsy excluded biliary obstruction, hepatic metastasis and primary hepatobiliary disease. Due to the absence of prostate abnormalities on imaging and lack of lower urinary tract symptoms, prostate cancer was not initially suspected. The diagnosis was ultimately established through biopsy of a splenic lesion, which confirmed metastatic prostate adenocarcinoma on immunohistochemistry. Serum prostate-specific antigen was measured only after histological confirmation and was markedly elevated. Following surgical androgen deprivation therapy, there was rapid and sustained improvement in cholestasis, supporting the diagnosis of icteric Stauffer syndrome secondary to prostate cancer.</p><p><strong>Learning points: </strong>Severe cholestatic jaundice may represent a paraneoplastic manifestation of occult prostate cancer.Normal biliary imaging, negative endoscopic evaluation and non-specific liver biopsy findings should prompt consideration of paraneoplastic cholestasis.Rapid biochemical improvement following oncologic treatment strongly supports the diagnosis of Stauffer syndrome.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"006232"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469636","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":"Primary Mediastinal Osteosarcoma: A Rare and Aggressive Tumour in an Unusual Location.","authors":"Hussein Rabah, Mohamed Hassan, Houssein Youness","doi":"10.12890/2026_006026","DOIUrl":"10.12890/2026_006026","url":null,"abstract":"<p><strong>Introduction: </strong>Mediastinal osteosarcoma is an exceptionally rare and aggressive malignancy arising in a location devoid of osseous structures. Unlike conventional osteosarcoma, which originates in the metaphyseal regions of long bones in younger individuals, mediastinal osteosarcoma develops within soft tissue, leading to a poorly understood pathogenesis and unpredictable clinical behaviour. Owing to its nonspecific symptoms and imaging overlap with other mediastinal tumours, early diagnosis is challenging. To date, around ten well-documented cases have been reported.</p><p><strong>Case description: </strong>A 41-year-old man presented with progressive dyspnoea of 3 months' duration. Laboratory tests were unremarkable except for elevated alkaline phosphatase. Computed tomography revealed a 10 × 8.8 cm calcified anterior mediastinal mass with multiple calcified pulmonary nodules and lymphadenopathy. Robotic bronchoscopy of a minimally calcified right middle lobe nodule revealed a high-grade sarcomatoid malignancy forming malignant osteoid. Tumour cells expressed SATB2 (Special AT-rich sequence-binding protein 2) and were negative for epithelial markers (Pancytokeratin, TTF-1, Napsin A, and P40). The findings favoured a diagnosis of extraskeletal osteosarcoma. Positron emission tomography/computed tomography scan demonstrated distant metastases to the brain and the absence of any primary bone lesions. The case was discussed in a multidisciplinary tumour board, and combined chemotherapy with Cisplatin and Doxorubicin was initiated, along with radiotherapy targeting the intracranial lesion, followed by Regorafenib, a kinase inhibitor.</p><p><strong>Conclusion: </strong>Mediastinal osteosarcoma should be considered in the differential diagnosis of calcified mediastinal masses. Accurate diagnosis depends on adequate tissue sampling and immunohistochemical profiling. Continued reporting of such rare cases is essential to improve understanding of clinical behaviour and optimize therapeutic strategies for these tumours.</p><p><strong>Learning points: </strong>Primary mediastinal osteosarcoma is a rare disease.Calcifications within a mediastinal tumour should raise suspicion of osteosarcoma.Due to the rarity of mediastinal osteosarcoma, there is no consensus on how to treat this tumour.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"006026"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469618","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":"Unmasking The Tiger Man: When Eosinophilic Myositis Mimics Sarcoidosis.","authors":"Jan Sanders, Elke Lodewijckx, Kristof Thevissen, Sander Jentjens, Lennert Boeckxstaens, Barbara Neerinckx, Ellen De Langhe","doi":"10.12890/2026_007105","DOIUrl":"10.12890/2026_007105","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic inflammatory myopathies are a heterogeneous group of disorders with overlapping clinical and imaging features. Advanced imaging such as ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET-CT) is increasingly used. The \"tiger man\" sign is a rare nuclear imaging sign associated with sarcoid myopathy and has been previously described in only two case reports of non-sarcoid myopathy. Eosinophilic fasciitis and myositis lie within a spectrum of eosinophil-associated disorders, for which evidence-based treatment remains limited. In this context, histopathological insights may offer significant diagnostic and therapeutic value.</p><p><strong>Case description: </strong>A 68-year-old male presented with pain and oedema of the lower legs and forearms, accompanied by recurrent nocturnal fever. He had a prior diagnosis of eosinophilic fasciitis two years earlier. Proximal muscle weakness of the upper legs was noted. Laboratory tests revealed systemic inflammation and elevated creatine kinase (CK) levels, suggestive of an inflammatory myopathy, while screening for infections and autoimmune serology was negative. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET-CT) imaging demonstrated a \"tiger man\" sign, characterized by extensive patchy ¹⁸F-FDG uptake in the skeletal muscles of all four extremities. Histopathological analysis confirmed a T-cell-mediated, necrotizing eosinophilic myositis, with no evidence of sarcoidosis or malignancy. Treatment with tacrolimus and plasma exchange resulted in significant clinical improvement and regression of ¹⁸F-FDG PET abnormalities.</p><p><strong>Conclusion: </strong>This is the third report of the \"tiger man\" sign in a patient with a non-sarcoid myopathy, thereby expanding the differential diagnosis for this imaging finding. Whole-body imaging can identify hypermetabolic yet clinically silent muscular regions, thereby guiding a more accessible and relevant site for biopsy. Histopathological findings can enhance diagnostic certainty and guide a more effective treatment.</p><p><strong>Learning points: </strong>A \"tiger man\" sign on ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography imaging is a rare and characteristic sign in sarcoid myopathy, but it is not disease-specific.Whole-body imaging can identify hypermetabolic yet clinically silent muscular regions, thereby guiding a more accessible site for biopsy.Histopathological analysis can enhance diagnostic certainty and guide a more effective treatment in the context of difficult to treat or idiopathic myositis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"007105"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469586","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 Presentation of Lyme Neuroborreliosis: Multifocal Cervical and Thoracic Transverse Myelitis-A Case Report.","authors":"Elmedina Shatri, Rrezarta Tërnava, Antoneta Gërdovci, Ilir Tolaj, Gëzim Morina","doi":"10.12890/2026_007103","DOIUrl":"10.12890/2026_007103","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord involvement in Lyme disease is an uncommon manifestation of neuroborreliosis, with myelitis representing a rare clinical entity. Multifocal transverse, non-contiguous spinal cord involvement remains particularly rare and is insufficiently characterized in the existing literature.</p><p><strong>Case report: </strong>We report the case of a 40-year-old previously healthy woman who presented with rapidly progressive paraparesis, ascending sensory deficits, and bladder and bowel dysfunction consistent with acute-subacute inflammatory myelopathy. Spinal magnetic resonance imaging (MRI) demonstrated multifocal non-contiguous inflammatory lesions involving the cervical and thoracic spinal cord. Extensive microbiological and serological investigations excluded alternative infectious aetiologies. Brain MRI showed no evidence of demyelinating disease. Despite clinically significant spinal cord inflammation, cerebrospinal fluid (CSF) analysis revealed neither pleocytosis nor elevated protein concentration. However, Borrelia-specific IgM antibodies were detected in both serum and CSF, and a positive Borrelia-specific antibody index (AI 3.07) confirmed intrathecal anti-Borrelia antibody synthesis, establishing the diagnosis of Lyme neuroborreliosis-associated myelitis. The patient subsequently demonstrated marked neurological improvement following targeted treatment with intravenous ceftriaxone combined with corticosteroids and supportive therapy.</p><p><strong>Conclusion: </strong>This case significantly expands the recognized spectrum of spinal cord involvement in Lyme disease-associated neuroborreliosis by delineating an extremely rare multifocal presentation, thereby emphasizing the critical importance of recognizing atypical manifestations in the diagnostic evaluation of inflammatory myelopathies.</p><p><strong>Learning points: </strong>Multifocal non-contiguous transverse myelitis is an unusual manifestation of Lyme neuroborreliosis.Lyme-associated inflammatory myelitis may occur even in the absence of classical cerebrospinal fluid abnormalities or documented tick exposure.Early recognition and antimicrobial treatment improve neurological recovery.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"007103"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469727","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 Bilateral Nephromegaly as the Initial Presentation of Acute Lymphoblastic Leukaemia: A Rare Case and Review of the Literature.","authors":"Rawan Hamdan, Mais Musleh, Mahmoud Alhamadeh Alswij, Yara Ibraheem, Miriam Laflouf, Abdulhalim Mohamed Alyousef","doi":"10.12890/2026_006944","DOIUrl":"10.12890/2026_006944","url":null,"abstract":"<p><strong>Introduction: </strong>Acute lymphoblastic leukaemia (ALL) is an aggressive hematologic malignancy, with T-cell ALL (T-ALL) accounting for approximately 25% of adult cases. Renal infiltration is recognized but rarely presents as isolated bilateral nephromegaly with acute kidney injury (AKI) in adults.</p><p><strong>Case description: </strong>A 32-year-old previously healthy man presented with progressive bilateral flank pain, abdominal heaviness, fatigue, intermittent fever, night sweats, and unintentional weight loss. Physical examination revealed large bilateral flank masses without peripheral lymphadenopathy. Laboratory tests initially showed normal blood counts but significant renal impairment (creatinine 3.5 mg/dl, urea 82 mg/dl). Imaging demonstrated massive bilateral kidney enlargement (~20 × 20 cm). Percutaneous renal biopsy revealed diffuse infiltration by medium-sized lymphoblasts expressing CD3 and TdT, confirming T-ALL. Within 1-week, hematologic abnormalities developed, including leucocytosis, anaemia, and thrombocytopenia, alongside worsening renal function and tumour lysis syndrome, necessitating dialysis and allopurinol therapy. The patient was started on a pre-phase corticosteroid regimen followed by intensive hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin [Adriamycin], and dexamethasone) induction chemotherapy. Initial radiologic improvement occurred; however, the clinical course was complicated by neutropenic sepsis, ultimately resulting in death.</p><p><strong>Conclusion: </strong>This case highlights a rare adult presentation of T-ALL in which renal involvement preceded hematologic abnormalities. Clinicians should consider hematologic malignancy in adults presenting with unexplained bilateral nephromegaly and AKI, even if initial blood counts are normal. Early recognition and timely intervention are critical to improve renal and overall outcomes.</p><p><strong>Learning points: </strong>Renal infiltration is recognized but rarely presents as isolated bilateral nephromegaly with acute kidney injury (AKI) in adults.This report underscores the importance of considering underlying hematologic malignancy in adults presenting with unexplained bilateral nephromegaly and AKI, even when initial hematologic investigations are normal.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"006944"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469353","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 Subglottic Rosai-Dorfman-Destombes Disease Causing Fixed Upper-Airway Obstruction in an Adult Woman.","authors":"Sheikh Abdullah, Camryn Herbert, Faryal Shoaib, Cole Bourgeois, Shiva Jashwanth Gaddam","doi":"10.12890/2026_006700","DOIUrl":"10.12890/2026_006700","url":null,"abstract":"<p><strong>Introduction: </strong>Rosai-Dorfman-Destombes disease (RDD) is a rare non-Langerhans cell histiocytosis that usually presents with painless cervical lymphadenopathy but may involve extranodal sites. Laryngeal or subglottic involvement is uncommon yet clinically significant because progressive fixed upper airway obstruction may initially resemble more common obstructive airway disease.</p><p><strong>Case description: </strong>We report a 59-year-old lifelong non-smoker with a history of mediastinal lymphadenopathy who developed several months of progressive exertional dyspnoea and wheeze treated as moderate persistent asthma with escalating inhaled therapy and repeated systemic steroids, without sustained improvement. Pulmonary evaluation demonstrated only mild obstructive physiology with air trapping and reduced diffusing capacity, discordant with the patient's marked exertional limitation. On follow-up, she was noted to have audible biphasic stridor, prompting urgent evaluation for central airway obstruction. Flexible laryngoscopy revealed an exophytic subglottic mass causing approximately 50% fixed airway obstruction. She underwent tracheostomy for airway protection followed by excision of the lesion. Histology demonstrated a lymphoplasmacytic infiltrate with large S100 and CD68 positive histiocytes showing emperipolesis, consistent with extranodal RDD. Cross sectional imaging excluded multifocal disease. She was decannulated and remains asymptomatic under surveillance.</p><p><strong>Conclusion: </strong>This case underscores that fixed central airway obstruction can masquerade as refractory asthma and that biphasic stridor may be the critical bedside clue prompting reconsideration of the diagnosis. Although subglottic RDD is rare, delayed recognition may lead to life-threatening airway compromise. Compared with the usual nodal presentation and often indolent clinical course of RDD, isolated subglottic disease is unusual and clinically significant because diagnosis depends on biopsy of a structural airway lesion and localized disease may have a favourable prognosis after endoscopic treatment and surveillance.</p><p><strong>Learning points: </strong>Progressive wheeze and dyspnoea with limited response to guideline-directed asthma therapy, particularly when symptom severity is disproportionate to spirometry, should prompt evaluation for non-asthma causes of airflow obstruction.Biphasic stridor is a key red flag for fixed central airway obstruction and warrants urgent airway visualization.Localized subglottic Rosai-Dorfman-Destombes disease, although rare, can be managed effectively with surgical debulking and temporary airway protection; systemic therapy is reserved for multifocal or organ threatening disease.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"006700"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469721","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":"Secondary Evans Syndrome Associated with Localized Clear Cell Renal Cell Carcinoma: A Case Report and Brief Literature Review.","authors":"Eloy Manerinc Peña Monge, Nahilia Carrasco-Randrianarison, Katherin Ponte-Fernandez","doi":"10.12890/2026_007101","DOIUrl":"10.12890/2026_007101","url":null,"abstract":"<p><strong>Introduction: </strong>Immune thrombocytopenia (ITP) and autoimmune haemolytic anaemia (AIHA) are uncommon paraneoplastic manifestations of solid tumours, and their association with renal cell carcinoma is exceptional.</p><p><strong>Case description: </strong>A 66-year-old man with no prior medical history presented with profound thrombocytopenia (5 ×10³/μl) and AIHA, confirmed by a strongly positive direct antiglobulin test with IgG and complement. Diagnostic work-up identified a left renal mass corresponding to localized clear cell renal cell carcinoma (pT1b). Bone marrow examination showed preserved megakaryopoiesis without dysplasia or infiltration, and peripheral smear confirmed true thrombocytopenia with macroplatelets. Thrombocytopenia persisted despite corticosteroids, intravenous immunoglobulin, and radical nephrectomy. Sustained platelet recovery was achieved with eltrombopag, a thrombopoietin receptor agonist (TPO-RA).</p><p><strong>Conclusion: </strong>Secondary Evans syndrome associated with localized renal cell carcinoma is an exceptionally rare disorder. Persistence of cytopenias after surgical tumour control does not rule out a paraneoplastic mechanism, and TPO-RAs may represent an effective option in refractory cases, although evidence in secondary ITP remains limited.</p><p><strong>Learning points: </strong>Secondary Evans syndrome (most commonly concurrent immune thrombocytopenia and autoimmune haemolytic anaemia) is an exceptionally rare paraneoplastic manifestation of localized clear cell renal cell carcinoma and requires rigorous diagnostic exclusion.Persistence of immune cytopenias for several weeks after curative nephrectomy does not exclude a paraneoplastic mechanism, as autoimmune activity may continue beyond tumour control.Thrombopoietin receptor agonists may be effective in immune thrombocytopenia secondary to solid tumours, a scenario with substantially less evidence than primary immune thrombocytopenia.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"007101"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469549","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":"Bronchoscopic Cuff Tamponade for Post-Intubation Tracheal Bleeding.","authors":"Trinh Viet Anh, Phan Thao Nguyen, Nguyen Cong Huu, Dinh Huu Tuan, Pham Xuan Hieu, Do Quoc Phong","doi":"10.12890/2026_006824","DOIUrl":"10.12890/2026_006824","url":null,"abstract":"<p><strong>Introduction: </strong>Post-intubation tracheal bleeding is a rare but potentially life-threatening cause of haemoptysis, particularly in patients on antithrombotic therapy after transcatheter aortic valve implantation (TAVI). Early source identification and airway control are essential, with bronchoscopy central to diagnosis and management.</p><p><strong>Case description: </strong>We report the case of a 66-year-old female who developed massive haemoptysis following TAVI and subsequent endotracheal intubation. Laboratory findings revealed a significant drop in haemoglobin, while imaging showed no evidence of parenchymal or vascular bleeding. Emergency bronchoscopy identified an active bleeding site on the posterior wall of the distal trachea. Under bronchoscopic guidance, the endotracheal tube cuff was repositioned and inflated to achieve direct tamponade. This intervention resulted in immediate and complete haemostasis. The cuff was maintained for 30 hours with close monitoring, and follow-up bronchoscopy confirmed cessation of bleeding and progressive mucosal healing. The patient was successfully extubated and discharged without recurrence.</p><p><strong>Conclusion: </strong>Bronchoscopically guided endotracheal tube cuff tamponade is an effective, minimally invasive, and readily applicable technique for controlling localized tracheal bleeding.</p><p><strong>Learning points: </strong>Tracheal bleeding after endotracheal intubation is a rare but potentially life-threatening cause of massive haemoptysis, particularly in patients receiving antithrombotic therapy after transcatheter aortic valve implantation.Early bronchoscopy is essential for accurate localization of the bleeding source and guidance of targeted, minimally invasive haemostatic interventions.Bronchoscopically guided endotracheal tube cuff tamponade is a simple, readily available, and effective bedside technique for controlling localized tracheal bleeding.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"006824"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469710","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":"Protracted Febrile Myalgia Syndrome as Initial Presentation of Familial Mediterranean Fever in a Patient of Northern European Extraction Thought to have Ulcerative Colitis.","authors":"Stephanie Ammari, Daniel Stein, Nawras Ibrahim","doi":"10.12890/2026_007090","DOIUrl":"10.12890/2026_007090","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Protracted febrile myalgia syndrome is a rare vasculitic manifestation of familial Mediterranean fever that presents as the initial familial Mediterranean fever manifestation in one-third of cases. While familial Mediterranean fever is classically autosomal recessive and associated with Mediterranean ancestry, the p.Met694del variant demonstrates autosomal dominant inheritance with a Northern European founder effect. MEFV-related enterocolitis can produce histologic features indistinguishable from inflammatory bowel disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case description: &lt;/strong&gt;A 24-year-old European American man with no Mediterranean, Middle Eastern or Armenian ancestry, with biopsy-confirmed ulcerative colitis on upadacitinib, presented with six weeks of high-grade fevers, incapacitating myalgias, a 30-pound weight loss and pericardial effusion. Faecal calprotectin was markedly elevated (&gt;8,000 μg/g) without gastrointestinal symptoms. Inflammatory markers were noticeably elevated with normal creatine kinase; extensive infectious and malignancy workup was negative. Bone marrow biopsy demonstrated focal haemophagocytosis without malignancy. Dramatic improvement occurred within 24-48 hours of corticosteroid initiation. Genetic testing revealed heterozygous p.Met694del, confirming autosomal dominant familial Mediterranean fever. At six-month follow-up on colchicine monotherapy without inflammatory bowel disease-directed therapy, inflammatory markers, faecal calprotectin and pericardial effusion had completely normalised, fulfilling Tel Hashomer criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This case highlights protracted febrile myalgia syndrome as an under-recognised initial presentation of autosomal dominant familial Mediterranean fever in non-Mediterranean populations. Colchicine-responsive normalisation of faecal calprotectin raises the possibility that MEFV-mediated enterocolitis contributed to intestinal inflammation initially attributed to ulcerative colitis. Early recognition enables amyloidosis prevention and essential genetic counselling for first-degree relatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Learning points: &lt;/strong&gt;Protracted febrile myalgia syndrome - prolonged fever, incapacitating myalgia and normal creatine kinase, should prompt consideration of familial Mediterranean fever regardless of ancestry, as the p.Met694del variant follows autosomal dominant inheritance with a Northern European founder effect.Colchicine-responsive normalisation of faecal calprotectin (&gt;8,000 to normal) without inflammatory bowel disease-directed therapy in a patient with biopsy-confirmed ulcerative colitis and a pathogenic MEFV variant, raises the possibility that MEFV-mediated enterocolitis contributed to intestinal inflammation initially attributed to inflammatory bowel disease, a distinction with direct therapeutic implications.Autosomal dominant MEFV variants carry critical implications for family counselling: first-degree relatives have a 50% ri","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"007090"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469553","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}