European journal of case reports in internal medicine最新文献_第7页

Prolonged disease control despite ALK inhibitor discontinuation in advanced ALK-positive NSCLC 晚期ALK阳性NSCLC患者停用ALK抑制剂后仍能延长疾病控制时间

European journal of case reports in internal medicine Pub Date : 2024-04-24 DOI: 10.12890/2024_004527

Syed Ather Hussain, Hafsa Faisal, Grace K. Dy

{"title":"Prolonged disease control despite ALK inhibitor discontinuation in advanced ALK-positive NSCLC","authors":"Syed Ather Hussain, Hafsa Faisal, Grace K. Dy","doi":"10.12890/2024_004527","DOIUrl":"https://doi.org/10.12890/2024_004527","url":null,"abstract":"Introduction: EML4-ALK is an oncogenic driver, seen in around five per cent of advanced non-small-cell lung cancer (NSCLC) patients, which can be targeted with anaplastic lymphoma kinase tyrosine kinase inhibitors with great response rates. Disease flare refers to sudden rapid disease worsening on tyrosine kinase inhibitors (TKI) discontinuation, which is associated with shorter survival and worse outcomes. Here, we review cases previously published in the literature where patients developed disease flares, and contrast this with our patients who had prolonged survival despite TKI discontinuation. Case description: We report three different patients with advanced ALK-positive NSCLC seen at our institute, who had EML4-ALK translocation variant 1 oncogenic driver on next-generation sequencing. They received treatment with several different ALK inhibitors before opting to discontinue TKI. They were able to come off TKI safely without developing disease flare and had prolonged survival. Discussion: Shorter time to progression on TKI, presence of symptoms with disease progression or central nervous system/pleural metastasis have been previously linked with development of flare, although this was not seen in our case series. Tumour response at the time of treatment discontinuation, line of therapy, overall disease burden, fusion variant and co-alteration status can affect the prognosis of these patients after ALK TKI cessation. In particular, variant 1 and wild-type TP53 status may be a suitable patient population for dose optimisation strategies. Intermittent TKI dosing strategies may help to avoid acquiring resistance mutations and prevent long-term treatment toxicities. Conclusion: It is important for clinicians to identify patients at risk for developing disease flare on TKI discontinuation to improve outcomes. Intermittent TKI dosing strategies require further investigation.","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

“A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapy "双重扭曲"--小细胞肺癌放疗罕见并发症引发化脓性心脏填塞的病例报告

European journal of case reports in internal medicine Pub Date : 2024-04-23 DOI: 10.12890/2024_004477

Diana Amorim, C. Miguel Goncalves, M. Cabral, Sónia Silva, Fátima Saraiva, J. Morais, Salvato Feijó

{"title":"“A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapy","authors":"Diana Amorim, C. Miguel Goncalves, M. Cabral, Sónia Silva, Fátima Saraiva, J. Morais, Salvato Feijó","doi":"10.12890/2024_004477","DOIUrl":"https://doi.org/10.12890/2024_004477","url":null,"abstract":"Background: Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy–induced pericardial disease can be a potential complication. Case Report: A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive Streptococcus pneumoniae. Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment. Conclusions: Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ketamine induced acute systolic heart failure 氯胺酮诱发急性收缩性心力衰竭

European journal of case reports in internal medicine Pub Date : 2024-04-23 DOI: 10.12890/2024_004470

Fares Saliba, Jonathan Mina, Laurence Aoun, Georges Khattar, Elie Bou Sanayeh, Jennifer Jdaidani, Ibrahim Al Saidi

{"title":"Ketamine induced acute systolic heart failure","authors":"Fares Saliba, Jonathan Mina, Laurence Aoun, Georges Khattar, Elie Bou Sanayeh, Jennifer Jdaidani, Ibrahim Al Saidi","doi":"10.12890/2024_004470","DOIUrl":"https://doi.org/10.12890/2024_004470","url":null,"abstract":"Background: Studies have shown major cardiovascular effects associated with ketamine use disorder including dose-dependent negative inotropic effects. Preoperative ketamine use has been linked to ketamine-induced stress cardiomyopathy. Case presentation: A 28-year-old female with a history of recurrent cystitis and ketamine use disorder (twice weekly for 14 years) presented with bilateral lower extremity oedema and shortness of breath for 3 months. She was tachycardic with a troponin level of 0.07 ng/ml and a B-type natriuretic peptide (BNP) level of 2511 pg/ml. Electrocardiogram showed normal sinus rhythm and transthoracic echocardiography (TTE) showed left ventricular ejection fraction (EF) of 15%, dilated left ventricle, and severe tricuspid and mitral regurgitation. Computed tomography (CT) scan of the chest and abdomen showed bilateral pleural effusions with congestive hepatopathy and ascites. The patient was started on intravenous furosemide, metoprolol, and sacubitril/valsartan. Rheumatological workup including complement levels, and antinuclear anti-double-stranded DNA was negative. A repeat TTE 2 weeks later revealed an EF of 25% and moderate tricuspid regurgitation. Four months later, the EF was 54% with normal left ventricular cavity size. Conclusion: Although ketamine use disorder is increasing, data on long-term side effects is minimal. Screening for ketamine use disorders should be considered in patients presenting with acute systolic heart failure. Long-term studies are needed to evaluate the benefits of adding ketamine screening to standard urine toxicology.","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140666615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The concomitant occurrence of hidradenitis suppurativa and Fournier’s gangrene 同时发生化脓性扁桃体炎和福尼尔坏疽

European journal of case reports in internal medicine Pub Date : 2024-04-23 DOI: 10.12890/2024_004493

Georges Khattar, Elie Bou Sanayeh, Marina Makram, Hussein Rabah, Saif Abu Baker, Salman Khan, Catherine Hong

{"title":"The concomitant occurrence of hidradenitis suppurativa and Fournier’s gangrene","authors":"Georges Khattar, Elie Bou Sanayeh, Marina Makram, Hussein Rabah, Saif Abu Baker, Salman Khan, Catherine Hong","doi":"10.12890/2024_004493","DOIUrl":"https://doi.org/10.12890/2024_004493","url":null,"abstract":"Background: Fournier’s gangrene represents a life-threatening necrotising infection affecting the perineal region, while hidradenitis suppurativa is characterised by a chronic inflammatory skin condition. The simultaneous occurrence of both conditions is exceedingly rare. Case description: A 42-year-old female with a documented history of severe untreated hidradenitis suppurativa presented for shortness of breath, fever and lethargy, along with extensive wounds and skin breakdown involving the left axilla, perineum, lower back, lumbosacral region and bilateral gluteal areas, extending to the perineum. Upon presentation, the patient was in a state of septic shock, and a diagnosis of actively manifesting Fournier’s gangrene was established at the site of the pre-existing hidradenitis suppurativa lesions. Despite the implementation of an aggressive multidisciplinary approach incorporating surgical interventions, antibiotic therapy and intensive care measures, the patient’s condition deteriorated, culminating in septic shock, multi-organ failure and eventual demise. In this report, we discuss both clinical entities, their similarities and differences, and the possible mechanisms by which they may have co-occurred. Conclusion: The co-existence of hidradenitis suppurativa and Fournier’s gangrene poses unique challenges, given the rapid progression of Fournier’s gangrene within the context of hidradenitis suppurativa, potentially suggesting the latter as a predisposing factor. This case underscores the importance of vigilant screening and management of hidradenitis suppurativa.","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Atypical pulmonary metastasis of prostate adenocarcinoma: a rare phenomenon 前列腺癌的非典型肺转移：一种罕见现象

European journal of case reports in internal medicine Pub Date : 2024-04-22 DOI: 10.12890/2024_004494

Asma Jamil, R. Ali, Amy Paige, Richard Miller, Nirav Mistry, Ahmed Abbas, A. Taha

引用次数: 0

Recurrent infective endocarditis of the mitral valve after orthotopic heart transplantation 正位心脏移植后复发的二尖瓣感染性心内膜炎

European journal of case reports in internal medicine Pub Date : 2024-04-22 DOI: 10.12890/2024_004528

P. Snopek, J. Hasilla, L. Pátrovič, Dominik Juskanič, J. Benko, M. Péč, M. Samoš

引用次数: 0

Syphilitic stomatitis: raising awareness on an often-overlooked presentation of secondary syphilis 梅毒性口腔炎：提高对经常被忽视的继发性梅毒表现的认识

European journal of case reports in internal medicine Pub Date : 2024-04-22 DOI: 10.12890/2024_004416

Henrique Atalaia-Barbacena, Catarina Isabel Lopes, Inês Matias Lopes, Patrícia Howell Monteiro

{"title":"Syphilitic stomatitis: raising awareness on an often-overlooked presentation of secondary syphilis","authors":"Henrique Atalaia-Barbacena, Catarina Isabel Lopes, Inês Matias Lopes, Patrícia Howell Monteiro","doi":"10.12890/2024_004416","DOIUrl":"https://doi.org/10.12890/2024_004416","url":null,"abstract":"Syphilis, a disease caused by the bacteria Treponema pallidum, has a multitude of clinical manifestations and is classified into primary syphilis, secondary syphilis and tertiary syphilis, based on clinical presentations and the time elapsed since the primary infection. The secondary stage of the disease can affect multiple organs and systems, and some of these involvements may be general and non-specific, justifying its name as ‘the great imitator’. We present a case of a 30-year-old woman with a history of painful neck lymph nodes with progressive enlargement, persistent headache, weight loss, myalgia and alopecia. During investigations, stomatitis on the dorsal face of the tongue developed. A secondary study showed serum positive for rapid plasma reagin (RPR) and T. pallidum haemagglutination (TPHA), negative RPR in cerebrospinal fluid and normal MRI, thus the diagnosis of secondary syphilis was made. The patient was treated with a single dose of penicillin with complete resolution of symptoms. The case highlights the need for an exhaustive clinical examination, especially in cases presenting with non-specific and general symptoms, and raises awareness for this disease which has increased its prevalence in the last decades.","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of chronic pulmonary aspergillosis due to pulmonary infarction, mimicking cryptogenic organising pneumonia 一例由肺梗塞引起的慢性肺曲霉菌病，模仿隐源性器质性肺炎

European journal of case reports in internal medicine Pub Date : 2024-04-22 DOI: 10.12890/2024_004501

Saki Yanoma, Motoi Ugajin, Hiasanori Kani

引用次数: 0

Cardiac sarcoidosis presenting as sustained ventricular tachycardia 表现为持续性室性心动过速的心脏肉瘤病

European journal of case reports in internal medicine Pub Date : 2024-04-17 DOI: 10.12890/2024_004298

N. Cotrim, Beatriz Vargas Andrade, Sofia Carralas Antunes, Miguel Rodrigues, Sílvia Aguiar Rosa, Marisa Peres, V. Martins

{"title":"Cardiac sarcoidosis presenting as sustained ventricular tachycardia","authors":"N. Cotrim, Beatriz Vargas Andrade, Sofia Carralas Antunes, Miguel Rodrigues, Sílvia Aguiar Rosa, Marisa Peres, V. Martins","doi":"10.12890/2024_004298","DOIUrl":"https://doi.org/10.12890/2024_004298","url":null,"abstract":"Introduction: Sarcoidosis has many possible clinical presentations since it can affect any organ, most commonly the lungs. The hallmark of the disease consists of the formation of non-necrotising granulomas. Pathogenesis is thought to rely on the interplay of genetic, environmental and epigenetic factors. This case highlights the importance of a thorough clinical history and physical examination, and the correlation with imaging findings in the diagnostic work-up of the non-ischaemic cardiomyopathy. Case description: A 57-year-old woman was admitted due to the sudden onset of malaise, dizziness, and chest discomfort. Sustained monomorphic ventricular tachycardia was evidenced and the patient rapidly evolved with haemodynamic instability; she underwent successful electrical cardioversion. The electrocardiogram afterwards showed a high-risk electrocardiographic pattern. Invasive coronary angiography excluded obstructive epicardial coronary lesions. Physical examination revealed skin lesions on the lower limbs which raised suspicion for erythema nodosum and therefore a biopsy was performed. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed features consistent with an inflammatory cardiomyopathy, and an implantable cardioverter-defibrillator was placed. The histologic examination of the cutaneous lesions showed a non-necrotising granulomatous inflammatory process. Radionuclide imaging was inconclusive. The patient underwent an endomyocardial biopsy, which confirmed the diagnosis of systemic sarcoidosis with cardiac involvement. Conclusions: Systemic sarcoidosis with cardiac involvement is a challenging diagnosis. The role of imaging techniques such as transthoracic echocardiography, cardiac magnetic resonance imaging and radionuclide imaging is essential in raising suspicion and diagnosing this pathology. Endomyocardial biopsy is the ‘gold standard’ for its diagnosis; however, it has a low diagnostic yield.","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Should histoplasmosis be screened for before initiation of tumour necrosis factor alpha inhibitors? 在开始使用肿瘤坏死因子α抑制剂之前，是否应筛查组织胞浆菌病？

European journal of case reports in internal medicine Pub Date : 2024-04-16 DOI: 10.12890/2024_004467

Srujan Edupuganti, Yashitha Chirumammilla, Manoj Upadhyay, Danielle Osterholzer

{"title":"Should histoplasmosis be screened for before initiation of tumour necrosis factor alpha inhibitors?","authors":"Srujan Edupuganti, Yashitha Chirumammilla, Manoj Upadhyay, Danielle Osterholzer","doi":"10.12890/2024_004467","DOIUrl":"https://doi.org/10.12890/2024_004467","url":null,"abstract":"Histoplasmosis is a soil based dimorphic fungus endemic to the Midwest and Southeastern United States and is responsible for infection through inhalation of conidia. Infection is usually asymptomatic, as the fungal growth is contained by formation of granulomas. However, dissemination can occur in immunocompromised hosts due to the lack of optimal activity of interferon gamma, tumor necrosis factor-alpha (TNF-alpha) and interleukin-17. There is a significant overlap between the symptomatology of histoplasmosis and granulomatosis with polyangiitis (GPA). We are reporting a case of a 48-year-old female who presented with high grade fever, worsening generalized weakness and tachycardia. She had a previous history of bilateral cavitary lung lesions for which she was evaluated at an outside facility. As her entire infectious work up was negative and found to be positive for antineutrophil cytoplasmic antibody (ANCA), a diagnosis of GPA was made and she was initiated on rituximab infusions 7 weeks prior to her presentation to our facility. Repeat infectious work up at our facility was positive for (1,3) beta-D-glucan test and urine histoplasma antigen. Prompt discontinuation of rituximab and initiation of systemic antifungal therapy led to clinical improvement. Based on this experience we would like to highlight the association of histoplasma with ANCA positivity along with the importance of closely monitoring these patients, for possible clinical worsening after the initiation of immunosuppressive therapy, despite the negative infectious work up. ","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140697144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0