European journal of case reports in internal medicine最新文献

{"title":"Giant Rectal Fecaloma Treated with Carbonated Soft Drink and Argon Plasma Coagulation.","authors":"Philippe Attieh, Karam Karam, Elias Fiani, Ihab I El Hajj","doi":"10.12890/2025_005280","DOIUrl":"https://doi.org/10.12890/2025_005280","url":null,"abstract":"<p><p>Constipation is a common gastrointestinal disorder affecting approximately 15% of the population, with a higher prevalence in women and older adults. It can be classified as primary, including functional constipation, pelvic floor dysfunction, and slow transit, or secondary, resulting from neurological, endocrine, metabolic disorders, cancer, or medications. In individuals over 75, constipation ranks as the seventh most common condition in primary care. A severe complication, fecal impaction, occurs more frequently in older adults and accounts for 0.03% of emergency department visits, with the highest risk in those over 85. In Parkinson's disease, constipation is a significant nonmotor symptom affecting up to 63% of patients and may lead to complications such as intestinal obstruction and aspiration pneumonia. We present the case of a 94-year-old male with Parkinson's disease who developed a 5 × 5 cm rectal fecaloma, unresponsive to standard endoscopic fragmentation techniques, including retrieval tools, high-pressure water jets, and polypectomy snares. Carbonated soft drink (Coca-Cola^®) injection (500 ml) was used to soften the fecaloma, followed by off-label argon plasma coagulation (APC) (30-50W, 2 l/min), which successfully facilitated further fragmentation and near-total removal. This case highlights the potential role of Coca-Cola^® and APC as adjunctive therapies in managing refractory fecalomas.</p><p><strong>Learning points: </strong>Standard fecaloma fragmentation methods failed necessitating the injection of a carbonated soft drink (Coca-Cola^®) into the lumen of the fecaloma and pouring its surface with it followed by the off-label use of argon plasma coagulation for full breakdown of the fecaloma.This highlights the importance of Coca-Cola^® and argon plasma coagulation as adjunctive therapies in managing refractory fecalomas, with further studies needed to propose the mechanism by which these tools can trigger fecalomas breakdown.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005280"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987092","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 as an Initial Presentation of Undiagnosed Systemic Lupus Erythematosus.","authors":"Lujain K Alharbi, Alaa K Ahmed","doi":"10.12890/2025_005336","DOIUrl":"https://doi.org/10.12890/2025_005336","url":null,"abstract":"<p><strong>Background: </strong>Haemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal hyperinflammatory syndrome with multi-organ involvement. It may occur secondary to autoimmune diseases such as systemic lupus erythematosus (SLE).</p><p><strong>Case description: </strong>This report describes an unusual case of a previously healthy 29-year-old female medical student who presented with a one-month history of recurrent fever, fatigue and significant weight loss. Initial laboratory investigations revealed pancytopaenia, hyperferritinaemia and hypertriglyceridaemia. Infectious disease workup was negative. Serological testing demonstrated positive antinuclear antibody and anti-double-stranded DNA antibodies, while bone marrow biopsy confirmed haemophagocytosis. The patient was diagnosed with secondary HLH due to SLE. During treatment in the intensive care unit, the patient developed psychosis manifested by visual hallucinations and mood swings. A diagnosis of neuropsychiatric SLE was confirmed by exclusion of other causes (e.g. steroid therapy) and the presence of non-specific white matter hyperintensities on brain magnetic resonance imaging. Combination therapy with high-dose corticosteroids, intravenous immunoglobulin and rituximab resulted in significant clinical and laboratory improvements within two weeks.</p><p><strong>Conclusion: </strong>This case illustrates how HLH can be the initial manifestation of previously undiagnosed SLE. Hence, clinicians should maintain a high index of suspicion for underlying autoimmune disorders such as SLE when evaluating patients with HLH, as early recognition and appropriate immunosuppressive therapy are crucial for optimal outcomes.</p><p><strong>Learning points: </strong>Clinicians should suspect haemophagocytic lymphohistiocytosis in patients with persistent fever and cytopaenias, especially when laboratory findings (e.g. hyperferritinaemia, hypertriglyceridaemia) do not improve with standard treatments.Systemic lupus erythematosus may initially present as secondary haemophagocytic lymphohistiocytosis. Integration of clinical, radiological and immunological data can aid in early differentiation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005336"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985905","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 Infective Endocarditis Caused by Beta-Lactam Resistant <i>Streptococcus Alactolyticus</i>.","authors":"Melina Ntoga, Vasileios Emmanouil, Eirini Terzi, Vasilios Petrakis, Periklis Panagopoulos, Dimitrios Papazoglou","doi":"10.12890/2025_005367","DOIUrl":"https://doi.org/10.12890/2025_005367","url":null,"abstract":"<p><strong>Background: </strong><i>Streptococcus alactolyticus</i> is a rare cause of human infections, with limited reports of infective endocarditis (IE).</p><p><strong>Case report: </strong>We present a case of a 68-year-old male with severe aortic stenosis who developed <i>S. alactolyticus</i> associated IE resistant to beta-lactams. Initial treatment with vancomycin and gentamicin led to temporary improvement, but the patient later developed complications, including splenic infarction and an aortic root abscess. Despite intensified antimicrobial therapy, he ultimately succumbed to multiorgan failure.</p><p><strong>Conclusion: </strong>This case underscores the importance of early identification of resistant pathogens, appropriate antibiotic selection, and vigilant monitoring for complications. The rising incidence of beta-lactam resistance in streptococcal infections highlights the need for ongoing epidemiological surveillance and research to optimize treatment strategies.</p><p><strong>Learning points: </strong><i>Streptococcus alactolyticus</i> is a rare but emerging cause of infective endocarditis that necessitates increased clinical awareness.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005367"},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978071","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":"The Lazarus Phenomenon - A Remarkable Case of Spontaneous Recovery from Cardiac Arrest in a Do-Not-Resuscitate Patient.","authors":"Bradley Fujiuchi, Akihiro Miyashita, Yusuke Hirao, Kevin Benavente","doi":"10.12890/2025_005308","DOIUrl":"https://doi.org/10.12890/2025_005308","url":null,"abstract":"<p><p>The Lazarus phenomenon, or autoresuscitation, is a rare clinical entity defined as the spontaneous return of circulation in patients following cardiac arrest. Here we report the case of an 88-year-old female who suffered cardiac arrest and received no intervention due to her code status. Despite this, she regained a pulse and consciousness after 167 seconds of pulseless ventricular tachycardia and 108 seconds of asystole consecutively, surviving through pacemaker placement and discharging 5 days later with an intact neurological status. We demonstrate that although rare, favorable outcomes with autoresuscitation are possible, even when no intervention is provided. We also provide a novel explanation for her recovery adding to existing theories on the mechanism of autoresuscitation.</p><p><strong>Learning points: </strong>Despite its rarity, autoresuscitation may result in favorable neurologic and functional outcomes even when cardiopulmonary resuscitation is not attempted.Patients should be monitored for at least 5 minutes prior to determination of circulatory death.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005308"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957578","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":"Reactive Arthritis.","authors":"Carolina António Santos, Frederico Trigueiros, Inês Machado Leite","doi":"10.12890/2025_005350","DOIUrl":"https://doi.org/10.12890/2025_005350","url":null,"abstract":"<p><p>Reactive arthritis is a form of seronegative spondylarthritis that presents following an infection, with clear associations to specific microorganisms. It is a rare entity and typically affects young adults. An 88-year-old woman, admitted in our ward with pseudomembranous enterocolitis and acute renal lesion, presented with axial oligoarthritis on the 11^th day after onset of symptoms. It was accompanied by elevation of inflammatory parameters - positive HLA-B27 and seronegative to rheumatoid factor, and anti-cyclic citrullinated peptide. The patient improved following treatment with non-steroidal anti-inflammatory drugs and inflammatory parameters normalised, with no recurrence after one year on follow-up. This case illustrates a rare entity in the elderly, with an established association in more recent years with <i>Clostridioides difficile</i>.</p><p><strong>Learning points: </strong>Post-infectious disease syndromes are poorly understood, and their management relies on their distinct pathophysiologies.Reactive arthritis can occur days or weeks after a gastrointestinal or urogenital bacterial infection and can present as Reiter's syndrome. The diagnosis is clinical, and its treatment should consider prevention, effective treatment of the causative agent and should target inflammation.We present a case of reactive arthritis that was diagnosed in an elderly patient (less common) with a trigger bacterium that has been implicated more and more consistently in recent years.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005350"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996302","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":"Monoclonal Gammopathy of Undetermined Significance with Associated Necrotizing Myopathy: A Case Report and Review of the Literature.","authors":"Anna Bode, Oscar F Borja Montes, Karen SantaCruz, Abu Baker Sheikh","doi":"10.12890/2025_005229","DOIUrl":"https://doi.org/10.12890/2025_005229","url":null,"abstract":"<p><strong>Background: </strong>Monoclonal gammopathies encompass many types of plasma cell proliferative disorders ranging from benign to malignant. Monoclonal gammopathies that meet diagnostic criteria for monoclonal gammopathies of undetermined significance (MGUS) but with clinical manifestations are now being referred to as monoclonal gammopathies of clinical significance (MGCS). MGUS associated myopathies are a rare form of MGCS.</p><p><strong>Case description: </strong>We present a case of MGUS associated necrotizing myositis. The patient had been previously diagnosed with MGUS and myositis around the same time, but prior testing had not revealed the etiology of the myopathy. Repeat biopsy and work-up revealed a necrotizing myopathy.</p><p><strong>Discussion: </strong>MGUS associated myopathies are rare, with the most common being sporadic late-onset nemaline myopathy (SLONM-MGUS) and amyloid light chain (AL) amyloidosis-associated myopathy. MGUS associated necrotizing myopathy is even rarer. Because this condition is so uncommon, there are no standardized guidelines on how to treat this condition. Some case reports or studies suggest treating the myositis with standard of care for the myositis type without considering the monoclonal gammopathy while other studies have suggested that treating the monoclonal gammopathy would be beneficial in treating the associated clinical syndrome.</p><p><strong>Conclusion: </strong>Our case report of MGUS associated necrotizing myopathy encourages internists to broaden their differential diagnosis of myopathy, increasing awareness of a condition that is still not well understood.</p><p><strong>Learning points: </strong>Monoclonal gammopathy of clinical significance is a new term that refers to nonmalignant monoclonal gammopathies that exhibit significant clinical manifestations.Monoclonal gammopathy associated myopathies are rare but should be considered as part of the differential diagnosis for myopathy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005229"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984079","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 Routine to Ruin: An Astonishing Computed Tomography Scan Reveals Catastrophic Ludwig's Angina and Necrotizing Mediastinitis after a Simple Dental Procedure.","authors":"Amer Abu-Shanab, Anoohya Vangala, Zain Albdour, Hamzeh Nasr, Malay Rathod, Doangton Du","doi":"10.12890/2025_005285","DOIUrl":"https://doi.org/10.12890/2025_005285","url":null,"abstract":"<p><p>Ludwig's angina is a rare, life-threatening cellulitis of the submandibular space, if unchecked, can rapidly progress to severe complications such as necrotizing mediastinitis, a condition with significant morbidity and mortality. We report the case of a 32-year-old male who developed this rare complication following wisdom tooth extraction. The patient presented with throat swelling and hematemesis, and contrast-enhanced computed tomography (CT) imaging had a decisive role in capturing the full extent of the infection, revealing severe airway narrowing, mediastinal free air, and a suspected superior vena cava thrombus. These imaging findings shaped critical clinical decisions, leading to urgent surgical drainage performed jointly by thoracic and ear, nose and throat teams along with aggressive therapy. CT not only guided treatment but also provided a roadmap for tracking disease resolution and detecting complications. Despite severe systemic involvement, including sepsis and hypotension, the patient responded well to a targeted antimicrobial regimen and supportive care. This case highlights the importance of multidisplinary work in such extensive cases, and emphasizes how radiology is more than a diagnostic tool and is an active force in shaping the management and outcome of complex infections, allowing for precise intervention before irreversible complications arise.</p><p><strong>Learning points: </strong>Ludwig's angina can rapidly progress to necrotizing mediastinitis, even after a routine dental procedure, making early recognition and timely intervention critical.Computed tomography is essential in assessing the extent of infection, identifying airway compromise and mediastinal involvement, which directly influence management decisions.A multidisciplinary approach, including early surgical intervention and aggressive antibiotic therapy, is crucial for optimizing outcomes in complex infections like necrotizing mediastinitis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005285"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958901","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":"Complete Response after Avelumab Maintenance Therapy: Successful Management of Metastatic Urothelial Carcinoma.","authors":"Rita Pinho, Maria João Oura, Francisco Botelho, Inês Nogueira Costa, Miguel Barbosa","doi":"10.12890/2025_005203","DOIUrl":"https://doi.org/10.12890/2025_005203","url":null,"abstract":"<p><p>Urothelial carcinoma is one of the most frequently diagnosed cancer types in the world and despite progress in treatment, it remains a lethal disease in the metastatic stage. Because of its high programmed cell death ligand 1 protein expression, it is associated with an increased response to immune checkpoints inhibitors. In the past few years, the gold standard for first-line treatment of metastatic urothelial carcinoma has been platinum-based chemotherapy, and avelumab (PD-1 inhibitor) maintenance therapy for non-progressing tumours. After the remarkable benefit demonstrated in the EV-302 study, the guidelines were recently revised to include enfortumab vedotin plus pembrolizumab as the new standard of care in this setting. Despite the new recommendations, in some countries, this combination is still pending approval. Furthermore, for patients who are ineligible for enfortumab vedotin plus pembrolizumab, platinum-based chemotherapy followed by avelumab maintenance therapy continues to be a preferred treatment option. This report presents a woman diagnosed with metastatic urothelial carcinoma with histologically confirmed complete response after cisplatin and gemcitabine chemotherapy and avelumab as maintenance therapy, which has been reported in only a few cases in the literature.</p><p><strong>Learning points: </strong>Urothelial carcinoma is associated with high mortality despite significant progresses in treatment.In metastatic urothelial carcinoma the first-line treatment was recently changed, with enfortumab vedotin plus pembrolizumab being approved by the US Food and Drug Administration and European Medicines Agency. Until now, platinum-based chemotherapy and avelumab maintenance therapy for non-progressing tumours was the only standard of care for these patients.In the literature, few cases have been reported with complete response to avelumab maintenance therapy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005203"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991536","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 50-Year-Old Woman with Severe Resting Hypoxia not Amendable to High-Flow Oxygen Supplementation.","authors":"Razi Even-Dar, Reem Mhamid, Karawan Badarni, Evelyne Shabad, Yaron Bar-Lavi, Yaniv Dotan","doi":"10.12890/2025_005069","DOIUrl":"https://doi.org/10.12890/2025_005069","url":null,"abstract":"<p><strong>Introduction: </strong>Pulse oximetry is a widely used non-invasive method to measure arterial oxygen saturation (SpO₂). However, haemoglobinopathies, including rare low-oxygen-affinity variants such as haemoglobin (Hb) Lansing can result in falsely low SpO₂ readings due to alterations in the Hb oxygen dissociation curve and spectral properties. Recognising these conditions is crucial to avoid misdiagnosis and unnecessary interventions.</p><p><strong>Case description: </strong>A 50-year-old female with a history of chronic obstructive pulmonary disease (COPD), hypertension and compensated cirrhosis presented for pre-operative evaluation. Persistent hypoxia (SpO₂ 84%), unresponsive to oxygen supplementation, was noted during routine assessment. Diagnostic investigations excluded pulmonary or cardiac shunts, hepatopulmonary syndrome and common causes of methaemoglobinaemia or carboxyhaemoglobinemia. Arterial blood gas analysis using a CO-oximeter revealed a true oxygen saturation of 90%, highlighting a discrepancy with pulse oximetry. Hb electrophoresis demonstrated an abnormal haemoglobin fraction, and subsequent genetic testing identified a heterozygous mutation (HBA1: c.264C>G), confirming Hb Lansing. The patient was asymptomatic apart from mild exertional dyspnoea attributed to underlying COPD and safely underwent planned surgery.</p><p><strong>Discussion: </strong>Hb Lansing is a rare haemoglobinopathy characterised by low oxygen affinity and high p50, leading to falsely low SpO₂ readings and minimal response to supplemental oxygen. Diagnosis relies on CO-oximetry, Hb electrophoresis and genetic analysis. No specific treatment is required for low-affinity haemoglobinopathies, which generally have a benign clinical course.</p><p><strong>Conclusion: </strong>Haemoglobinopathies should be considered in the differential diagnosis of unexplained hypoxia. Utilisation of targeted diagnostic tools enables clinicians to ensure accurate diagnosis and appropriate management.</p><p><strong>Learning points: </strong>The differential diagnosis of hypoxia, non-amendable to supplemental oxygen in a stable patient mainly includes right to left pulmonary or cardiac shunt, or a haemoglobinopathy with altered oxygen affinity.Clinicians should be familiar with instances in which pulse oximetry is not reliable, including poor tissue perfusion, certain nail polish types and haemoglobinopathies, and should obtain arterial blood gas for accurate assessment.If haemoglobinopathy is suspected, it is advisable to perform arterial blood gas analysis using a multi-wavelength spectrometer for accurate assessment.Early performance of haemoglobin electrophoresis followed by mutational analysis will yield diagnosis and prevent further work-up.The clinical course of low-oxygen-affinity haemoglobinopathies is mild, and patients should not be denied necessary surgical interventions due to this condition.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005069"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978882","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":"Entrectinib-Induced Brugada Syndrome Leading to Ventricular Tachycardia in A Patient with ROS1 Fusion-Positive Lung Adenocarcinoma.","authors":"Nobuo Ishiguro, Takeshi Mori, Makito Kaneshiro, Shin Hasegawa, Akimitsu Tanaka, Miyuki Ando, Kazuo Kato","doi":"10.12890/2025_005232","DOIUrl":"https://doi.org/10.12890/2025_005232","url":null,"abstract":"<p><p>A 65-year-old male presented to the emergency room after experiencing syncope while driving, causing a self-inflicted accident. He had previously been diagnosed with stage IV A (cTXN2M1a) lung adenocarcinoma with C-ROS oncogene 1 (ROS1) fusion gene, wherein entrectinib (a multikinase inhibitor of ROS1, 600 mg orally once daily) was initiated as the first-line chemotherapy 12 days prior. He presented with haemodynamically unstable conditions without fever (blood pressure 89/42 mmHg; heart rate, 180/min). The 12-lead electrocardiogram revealed ventricular tachycardia (VT) with a left bundle branch block and right axis deviation. Synchronised electrical cardioversion terminated the sustained VT, and the post-electrocardiogram exhibited coved-type ST-segment elevation in V1 to V3. An emergency coronary angiography showed no abnormal findings. Coved-type ST-segment elevation in V1 to V3 persisted for two days following cessation of entrectinib; however, electrocardiogram findings gradually normalised, with no recurrence of clinical VT. Catheter ablation for VT was initially planned; however, the consultant pulmonologist considered that entrectinib could induce Brugada syndrome (BrS), resulting in sustained VT. Therefore, the plan was suspended and entrectinib was discontinued. Electrophysiological examination with programmed electrical and pilsicainide infusion for risk stratification failed to induce clinical VT, and the patient was considered at low risk for VT recurrence following entrectinib discontinuation. Accordingly, we opted for close observation. At the one-year follow-up, no ventricular arrhythmias were noted. The relationship between entrectinib and drug-induced BrS remains unclear, with few reported cases. Continuous or frequent electrocardiogram monitoring during hospitalisation post entrectinib initiation may help detect entrectinib-induced BrS.</p><p><strong>Learning points: </strong>The relationship between entrectinib and drug-induced Brugada syndrome remains unclear, and reports of entrectinib-induced Brugada syndrome are rare.We performed risk stratification using electrophysiological examinations in a case of entrectinib-induced Brugada syndrome in a patient with ROS1 fusion-positive lung adenocarcinoma.Our results suggest that continuous electrocardiogram monitoring or frequent electrocardiogram recording at least once a day several days following entrectinib initiation may help detect entrectinib-induced Brugada syndrome irrespective of being in or out of hospital.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005232"},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986739","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}