European journal of case reports in internal medicine最新文献

{"title":"Distal Renal Tubular Acidosis Secondary to Hyperbilirubinemia.","authors":"Fawzi Srour, Aline Pourcelet, Ishak Beklevic, Guillaume Benoit, Serge Treille de Grandsaigne, Nathan Neveux","doi":"10.12890/2025_005661","DOIUrl":"10.12890/2025_005661","url":null,"abstract":"<p><strong>Introduction: </strong>Bile cast nephropathy (BCN) is a rare and often overlooked cause of acute kidney injury (AKI), usually seen in the context of severe hyperbilirubinemia. It results from the deposition of bile pigments and bile casts in renal tubules, specifically distal and collector tubules, leading to obstruction and direct tubular toxicity.</p><p><strong>Case description: </strong>We describe the case of 49-year-old male who presented with severe jaundice and oliguric AKI. With the gradual resolution of liver dysfunction, the patient's kidney function also improved. However, during the recovery phase, the patient developed persistent hypokalaemia and normal anion gap metabolic acidosis. Further work-up was consistent with distal renal tubular acidosis (dRTA).</p><p><strong>Discussion: </strong>While BCN is being increasingly recognized in patients with cholestatic liver diseases, complications arising during the recovery phase - particularly acid-base disturbances like dRTA - are rarely reported. In this case, the onset of dRTA during renal recovery may reflect delayed or selective tubular healing after bile-induced injury. This case highlights the importance of continued monitoring for renal tubular defects even after apparent improvement in glomerular function.</p><p><strong>Conclusion: </strong>This case emphasizes the need to consider dRTA as a potential complication in patients recovering from BCN. Close follow-up of electrolyte and acid-base parameters is advised during renal recovery, especially in the presence of persistent hypokalaemia.</p><p><strong>Learning points: </strong>Bile cast nephropathy (BCN) is an under-recognized cause of acute kidney injury (AKI) in patients with severe hyperbilirubinemia and should be considered in the differential diagnosis of AKI in jaundiced patients.Distal renal tubular acidosis (dRTA) can emerge during the recovery phase of BCN-related AKI, possibly due to tubular dysfunction from bile-induced injury, highlighting the need for close metabolic monitoring after renal recovery.The co-occurrence of BCN and dRTA emphasizes the importance of serial electrolyte assessments and acid-base evaluation in jaundiced patients with AKI, even after apparent improvement in renal function.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005661"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816128","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 Novel, Non-Invasive AI-Based Telemonitoring System for Heart Failure: Detection of Undiagnosed Hyperthyroidism in an Asymptomatic Patient.","authors":"Allan Böhm, Julia Lucka, Amitai Segev, Marta Kollarova, Stefan Toth, Nikola Jajcay, Branislav Bezak","doi":"10.12890/2025_005420","DOIUrl":"10.12890/2025_005420","url":null,"abstract":"<p><strong>Background: </strong>Untreated thyroid disorders may precipitate heart failure (HF) decompensation. Assessment of cardiac filling pressures may aid in the early detection and prevention of clinical decompensation. Therapy guided by monitoring of cardiac filling pressures has been shown to improve quality of life and survival and reduce hospitalizations of individuals with HF. We have developed a non-invasive method to assess left ventricular filling pressures (LVFP) by analysing the photoplethysmography signal with Seeling HeartCore technology (Seerlinq, Bratislava, Slovakia).</p><p><strong>Case description: </strong>A 99-year-old female visited the clinic for a routine cardiac check-up. Laboratory investigations showed elevated NTproBNP and moderately elevated high sensitive troponin T. HeartCore algorithm indicated elevated LVFP. As part of the evaluation of worsening of sub-clinical HF, extended laboratory tests revealed low thyroid-stimulating hormone with high free thyroxine levels indicating increased thyroid function. The endocrinologist diagnosed hyperthyroidism with multinodular goitre and prescribed thiamazole. To prevent progression to clinical HF decompensation, the dose of furosemide was increased. At 4 months, during scheduled cardiac follow-up, the patient was clinically doing well, without any signs or symptoms of HF.</p><p><strong>Discussion: </strong>Remote monitoring devices that track pressures in the pulmonary artery require invasive implantation and are associated to potential complications. The high cost of these devices presents a significant barrier to widespread use. SEERLINQ is a novel system for remote haemodynamic monitoring based on non-invasive assessment of LVFP, presenting a promising alternative to current invasive methods.</p><p><strong>Conclusion: </strong>This case underscores the potential benefits of this technology in the early recognition of pre-clinical deterioration and its implementation for remote home monitoring in patients with HF.</p><p><strong>Learning points: </strong>Untreated thyroid disorders in patients with heart failure (HF) can exacerbate signs and symptoms of HF.Left ventricular filling pressure (LVFP) rises 3-4 weeks before HF symptoms. Echocardiographic assessment of LVFP can be challenging in patients with atrial fibrillation or paced rhythms.Photoplethysmography-based analysis could be utilized to assess LVFP, enabling remote monitoring of HF patients and potentially preventing HF decompensation and hospitalization.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005420"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816121","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 Pancreatitis Associated with Tacrolimus in A Lung Transplant Recipient: A Case Report and Review of Literature.","authors":"Ana Šmaguc, Maja Mačković, Nikolina Marić, Nikola Udiljak","doi":"10.12890/2025_005619","DOIUrl":"10.12890/2025_005619","url":null,"abstract":"<p><strong>Background: </strong>Tacrolimus is a commonly used immunosuppressant with well-defined side effects, including hypertriglyceridemia and hyperglycaemia. However, acute pancreatitis is still not widely recognized as an adverse event related to tacrolimus.</p><p><strong>Case presentation: </strong>A 60-year-old male was admitted to the intensive care unit with symptoms and signs of acute pancreatitis. He underwent lung transplantation 4 years ago and since then received tacrolimus, mycophenolate mofetil (MMF) and prednisone. His initial laboratory tests revealed elevated serum amylase and lipase, high inflammatory parameters, markedly elevated triglycerides and hyperglycemia with diabetic ketoacidosis. He was treated with continuous insulin infusion, electrolyte correction, crystalloid titration and antimicrobial therapy. During the fasting period, immunosuppression was maintained with parenteral methylprednisolone and tacrolimus. Gradually, oral tacrolimus, MMF and full enteral nutrition were introduced. A control computed tomography scan showed pancreatic body necrosis with a large pseudocyst. The patient was discharged on a strict diet, fenofibrate and short- and long-acting insulin. Immunosuppressive therapy with tacrolimus, MMF and prednisone was continued. He was hospitalized several times within a year due to complications of severe necrotizing pancreatitis.</p><p><strong>Conclusion: </strong>Acute pancreatitis associated with the use of tacrolimus is rare. Factors contributing to its occurrence are longer exposure period, toxic levels of the drug and concurrent metabolic derangements, predominantly hypertriglyceridemia. In this case report we present a patient after lung transplantation on tacrolimus therapy who developed severe acute necrotizing pancreatitis along with hypertriglyceridemia and diabetes mellitus. We also conducted a literature search and found 13 other cases of acute pancreatitis presumably related to tacrolimus therapy.</p><p><strong>Learning points: </strong>Tacrolimus related complications including metabolic changes are commonly observed.Development of acute pancreatitis is one of the rare complications of tacrolimus therapy, seldomly reported in transplant recipients.The definitive therapeutic approach is still to be determined.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005619"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029334","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":"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}