European journal of case reports in internal medicine最新文献

{"title":"When Eosinophils Mislead: Gastrointestinal Basidiobolomycosis Initially Misdiagnosed as Eosinophilic Colitis.","authors":"Yaqoub Alshatti, Shaikhah Alshammari, Mashaan Alenezi, Muneera Alhamadi, Waleed Alkanderi","doi":"10.12890/2026_006691","DOIUrl":"10.12890/2026_006691","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection caused by <i>Basidiobolus ranarum</i> that predominantly affects immunocompetent individuals in tropical and subtropical regions. It frequently mimics colonic malignancy or inflammatory bowel disease, leading to significant diagnostic delays.</p><p><strong>Case description: </strong>A 36-year-old previously healthy Indian male presented with a 1-month history of abdominal pain, bleeding per rectum, and weight loss. Computed tomography scan revealed circumferential wall thickening of the ascending colon from the ileocecal junction to the hepatic flexure with loco-regional and para-aortic lymphadenopathy. Colonoscopy demonstrated a large circumferential inflammatory mass causing significant luminal narrowing. Initial histopathology from endoscopic biopsies was interpreted as eosinophilic colitis. However, expert review identified broad, pauciseptate fungal hyphae surrounded by eosinophilic material consistent with the Splendore-Hoeppli phenomenon, confirming GIB. The patient was commenced on oral itraconazole 200 mg twice daily with significant clinical, biochemical, and radiological improvement at 3-month follow-up, without the need for surgical intervention.</p><p><strong>Discussion: </strong>This case highlights the diagnostic pitfall of misinterpreting GIB as eosinophilic colitis on superficial endoscopic biopsies and demonstrates successful non-surgical management with itraconazole monotherapy.</p><p><strong>Conclusion: </strong>GIB should be considered in the differential diagnosis of obstructing colonic masses in immunocompetent patients with eosinophilia. When initial biopsies suggest eosinophilic colitis in the context of a mass lesion, expert histopathological review with attention to fungal elements is essential.</p><p><strong>Learning points: </strong>Gastrointestinal basidiobolomycosis (GIB) can closely mimic colonic carcinoma or inflammatory bowel disease endoscopically and radiologically; a high index of suspicion is essential in immunocompetent patients presenting with obstructing colonic masses and peripheral eosinophilia in tropical and subtropical regions.Superficial endoscopic biopsies in GIB frequently yield dense eosinophilic infiltration misdiagnosed as eosinophilic colitis; expert histopathological review focusing on the Splendore-Hoeppli phenomenon on haematoxylin and eosin stain can be diagnostic, and special stains (Grocott-Gomori methenamine silver, periodic acid-Schiff) should be requested when available to further confirm the diagnosis.Early diagnosis of GIB enables curative antifungal therapy and may avert unnecessary surgical resection, underscoring the importance of including this entity in the differential diagnosis of colonic masses with inconclusive initial histopathology.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006691"},"PeriodicalIF":0.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210638","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":"Distal Renal Tubular Acidosis in Pregnancy: A Case Report and Systematic Literature Review.","authors":"Muhammad Sabisi, Erika Kusumawardani, Apriani Lam, Safira Putri, Eric Fernando","doi":"10.12890/2026_006821","DOIUrl":"10.12890/2026_006821","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Distal renal tubular acidosis (dRTA) is a rare disorder characterized by normal anion gap metabolic acidosis and hypokalaemia. Physiological changes during pregnancy may aggravate acid-base imbalance and influence foetal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case description: &lt;/strong&gt;A 40-year-old pregnant woman at 24-25 weeks of gestation presented with recurrent hypokalaemia and lower limb weakness. Laboratory findings showed normal anion gap metabolic acidosis, consistent with dRTA. The patient was treated with oral potassium supplementation and intravenous sodium bicarbonate, resulting in clinical improvement. In the third trimester, intrauterine growth restriction was identified. Delivery at term resulted in a live neonate with low birth weight.A literature review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using PubMed, ScienceDirect, Wiley Online Library, SpringerLink, and ResearchGate for studies published between 2016 and 2026. Ten case reports met the inclusion criteria. Distal RTA was the most frequently reported subtype, accounting for 80% of cases. Most cases (70%) were first diagnosed during pregnancy. The most common treatment strategy was potassium supplementation combined with bicarbonate therapy (90%), administered either orally, intravenously, or as combination therapy. Adverse neonatal outcomes were reported in 50% of cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Distal RTA should be considered in pregnant patients presenting with recurrent hypokalaemia and muscle weakness. Early recognition and appropriate correction of electrolyte imbalance and metabolic acidosis are essential to optimize maternal and foetal condition. Further studies are needed to better define clinical characteristics and management strategies of renal tubular acidosis during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Learning points: &lt;/strong&gt;&lt;b&gt;Vigilance is essential for rare distal renal tubular acidosis (dRTA)-pregnancy overlap&lt;/b&gt; As the leading form of RTA, (seen in 80% of reported cases), distal RTA (dRTA) frequently first appears during pregnancy (70% of instances), where it closely resembles routine hypokalaemic conditions. Clinicians should routinely check for anion-gap metabolic acidosis in pregnant women experiencing repeated muscle weakness, allowing timely treatment to avert severe maternal decline.&lt;b&gt;Bicarbonate and potassium therapy boosts maternal-foetal success&lt;/b&gt; In this case, combined oral and intravenous replacement (effective in 90% of documented scenarios) quickly alleviated symptoms, yet the 50% chance of neonatal issues like intrauterine growth restriction or low birth weight underscores the approach's value for the foetus, providing internists with a reliable, safe strategy amid pregnancy's natural acid-base changes.&lt;b&gt;Diagnostic pathway to reveal hidden dRTA dangers&lt;/b&gt; This experience arms internists with a straightforward algorithm (start with hypokalaemia evaluation,","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006821"},"PeriodicalIF":0.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210724","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 Rectal Neurofibroma in the Absence of Neurofibromatosis: Report and Review of Molecular Implications.","authors":"Karam Karam, Kim Charro, Ariane Alirkilicarslan, Aurélien Morini, Jacquot Rakotobe, Emilien Brousset, Christophe Locher","doi":"10.12890/2026_006508","DOIUrl":"10.12890/2026_006508","url":null,"abstract":"<p><p>Neurofibromas are benign peripheral nerve sheath neoplasms composed of Schwann cells, fibroblasts, perineurial-like cells and axonal elements within a variably collagenous or myxoid stroma. They most commonly arise in the context of neurofibromatosis type 1 (NF1), an autosomal dominant tumour predisposition syndrome driven by inactivating mutations of the NF1 tumour suppressor gene. Isolated colorectal neurofibromas unassociated with syndromic disease are exceptionally rare, and their biological behaviour remains incompletely characterised. We report a case of a 26-year-old man presenting with non-specific abdominal pain who was found to have a solitary rectal submucosal lesion. Endoscopic resection was performed, and histopathologic and immunophenotypic evaluation confirmed the diagnosis of an isolated rectal neurofibroma. This case underscores the diagnostic and management challenges posed by these rare lesions and highlights unresolved questions regarding their molecular underpinnings and malignant potential.</p><p><strong>Learning points: </strong>Isolated rectal neurofibromas are extremely rare, particularly without evidence of neurofibromatosis.Gastrointestinal neurofibromas are usually linked to systemic syndromes, especially neurofibromatosis type 1. The lesion can mimic other rectal tumours such as gastrointestinal stromal tumour (GIST), schwannoma or rectal carcinoid tumour.Diagnosis usually requires histopathology and immunohistochemistry.This case highlights the importance of considering rare nerve sheath tumours in the differential diagnosis of rectal lesions.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006508"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210592","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 Cardiomyopathy to Remember: A Case Report of Desmoplakin Cardiomyopathy.","authors":"Tarek Mahdy, Salaheldin Agamy, Mahmoud Khedr, George Doos, Mohamed Mansour, Mubarak Ahamed","doi":"10.12890/2026_006749","DOIUrl":"10.12890/2026_006749","url":null,"abstract":"<p><strong>Introduction: </strong>Arrhythmogenic cardiomyopathies are an under-investigated common cause for myocardial infarction with no obstructive coronary artery disease.</p><p><strong>Case description: </strong>A 56-year-old male presented with myocardial infarction with no obstructive coronary artery disease in three different occasions. His transthoracic echocardiography showed dropped left ventricle function in the last presentation. This was further investigated by cardiac magnetic resonance imaging which showed distinguishable pattern of myocardial fibrosis. He had primary prevention with an implantable cardioverter-defibrillator. He tested positive for pathological variant for the desmoplakin (DSP) gene.</p><p><strong>Conclusion: </strong>Recurrent myocardial injury left ventricular fibrosis, and frequent premature ventricular contractions should always raise the suspicion of DSP cardiomyopathy.</p><p><strong>Learning points: </strong>Recurrent episodes of myocardial infarction with non-obstructive coronary artery disease should raise the suspicion of desmoplakin cardiomyopathy.Cardiac magnetic resonance imaging is the gold standard imaging tool for diagnosis.No consensus regarding risk assessment however primary prevention towards ventricular arrhythmias needs to be considered.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006749"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210684","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":"Serological Interference Related to Intravenous Immunoglobulins: A Case of False Immunization Against Hepatitis B Virus.","authors":"Hajar Fadili, Jihane Smaali, Malak Snoussi, Fadwa Ousti, Abdelhamid Zrara, Jalila El Bakkouri","doi":"10.12890/2026_006714","DOIUrl":"10.12890/2026_006714","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous immunoglobulins (IVIG) are derived from pooled plasma obtained from thousands of donors and are widely used in the treatment of inflammatory, infectious, and immunodeficiency disorders. Due to their origin, these preparations may contain antibodies directed against various infectious agents. Their administration can therefore result in passive transfer of antibodies, potentially interfering with the interpretation of certain serological tests.</p><p><strong>Case description: </strong>We report a case of false-positive anti-HBs antibodies observed following IVIG administration in a patient with no prior history of vaccination, who was being followed for polyarteritis nodosa with resistance to first- and second-line therapies.Serological testing was performed as part of a pre-therapeutic workup prior to initiation of tocilizumab. Subsequent follow-up tests demonstrated a progressive decline in antibody titres, consistent with the clearance of passively transferred immunoglobulins.</p><p><strong>Discussion: </strong>Passive transfer of anti-HBs and anti-HBc antibodies, as well as other antibodies targeting infectious agents or autoimmune antigens following IVIG administration, has been previously described in the literature. This situation is of particular clinical relevance in patients who are candidates for immunosuppressive therapy, which may induce reactivation of certain pathogens. Misinterpretation of these results may lead either to unnecessary prophylactic treatment or to inappropriate modification or delay of essential immunosuppressive therapy. To avoid misleading results, it is recommended to perform baseline serological screening prior to IVIG initiation, to store a reference serum sample for potential retrospective analysis, and, in patients receiving high doses, to avoid IgG-based serological assays in favour of diagnostic methods such as polymerase chain reaction.</p><p><strong>Conclusion: </strong>Increased awareness among clinicians and laboratory specialists is essential to prevent unnecessary investigations and delays in appropriate patient management.</p><p><strong>Learning points: </strong>False-positive serological results following intravenous immunoglobulin (IVIG) therapy, may lead to diagnostic confusion and unnecessary investigations.Internists should consider recent IVIG administration when interpreting serological tests, to avoid misdiagnosis and inappropriate management.Careful timing and interpretation of serological tests in patients receiving IVIG is essential.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006714"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210650","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":"Thromboembolic Nstemi from a 9.4 × 7.3 mm Mid-Left Circumflex Artery Aneurysm with a Zero Calcium Score and Non-Obstructive Coronary Arteries.","authors":"Abdelrahman Shehata, Gargi Sharma, Abdus Md Sakur, Alina Hakim, Dristi Naraindas Varandani, Mohamed Hussien Abbas","doi":"10.12890/2026_006148","DOIUrl":"10.12890/2026_006148","url":null,"abstract":"<p><strong>Introduction: </strong>Coronary artery aneurysms (CAAs) are uncommon and can cause acute coronary syndromes due to thromboembolism despite the absence of obstructive coronary disease.</p><p><strong>Case description: </strong>We report the case of a 51-year-old patient with hypertension and hypercholesterolemia with the chief complaint of chest pain and elevated troponin, which is typical of non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography showed non-obstructive coronary arteries and a calcium score of 0 with 9.4 × 7.3 mm middle-left circumflex artery aneurysm with thrombosis. Thrombus aspiration was effectively done without stenting. The patient was treated using dual antiplatelet therapy and statin therapy, and clinical improvement was achieved. The case in point demonstrates an infrequent pathophysiology of NSTEMI due to thromboembolism in a tiny aneurysm without severe atherosclerosis. Multimodality imaging was essential for diagnosis. Management was conservative. Transthoracic echocardiography revealed mild left ventricular hypertrophy with inferior hyperkinesia along with preserved ejection fraction. The patient was hemodynamically stable throughout hospitalization and was discharged on optimal medical therapy having no recurrent symptoms.</p><p><strong>Conclusion: </strong>NSTEMI may be caused by small CAAs through thromboembolism even though the coronary artery calcium score is zero. Personalized care (thrombus aspiration and optimal medical therapy) can yield excellent outcomes.</p><p><strong>Learning points: </strong>A non-ST-segment elevation myocardial infarction can occur in the absence of obstructive coronary disease because of thromboembolism from a small coronary aneurysm, even with a coronary artery calcium score of zero.Multimodality imaging is crucial for precise diagnosis along with management of coronary artery aneurysms.Conservative management with thrombus aspiration along with medical therapy may be effective in selected patients.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006148"},"PeriodicalIF":0.0,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210618","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":"Slipping Rib Syndrome Presenting as Postprandial Nausea: A Diagnostic Challenge in Internal Medicine.","authors":"Valentin Mihail Botusanu, Catalina Ioana Ursu","doi":"10.12890/2026_006756","DOIUrl":"10.12890/2026_006756","url":null,"abstract":"<p><p>Slipping rib syndrome is an under-recognised cause of thoracoabdominal pain that may present with atypical symptoms, leading to diagnostic delay. We report the case of a 23-year-old woman who presented with severe postprandial nausea as her dominant symptom, accompanied by episodic vomiting and unintentional weight loss. Extensive gastrointestinal and spinal investigations were unrevealing, and symptoms were subsequently interpreted as functional or psychosomatic. Careful clinical examination and targeted imaging ultimately identified slipping rib syndrome involving the eleventh right rib. Surgical resection of the mobile cartilaginous rib segment resulted in complete and sustained resolution of symptoms. This case highlights the importance of considering musculoskeletal causes in patients with unexplained gastrointestinal symptoms to avoid misdiagnosis and unnecessary investigations.</p><p><strong>Learning points: </strong>Slipping rib syndrome may present predominantly with gastrointestinal symptoms such as postprandial nausea, leading to diagnostic delay.Reproducible mechanical symptoms on examination are key to diagnosis, and normal imaging does not exclude the condition.Surgical resection can provide definitive symptom relief in selected patients with persistent symptoms.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006756"},"PeriodicalIF":0.0,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210627","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":"Reversible St-Segment Elevation in the Setting of Acute Esophagitis Caused by Caustic Drain Cleaner Ingestion.","authors":"Ahmed Ali, Ahmed Awab, Hafiz Fakih","doi":"10.12890/2026_006564","DOIUrl":"10.12890/2026_006564","url":null,"abstract":"<p><strong>Background: </strong>Caustic ingestion remains a significant clinical challenge, often resulting in severe transmural oesophageal injury. Given the immediate anatomical proximity of the oesophagus to the left atrium and ventricle, severe inflammation can extend to adjacent cardiac structures, potentially mimicking acute coronary syndrome.</p><p><strong>Case description: </strong>A 22-year-old male presented following the intentional ingestion of sodium hydroxide drain cleaner. Initial endoscopy identified injury that rapidly progressed from Zargar grade 1 to 3B. Simultaneously, the patient developed acute ST-segment elevation and a marked troponin elevation of 85.15 ng/ml. Despite these findings, echocardiography confirmed normal ventricular function and no pericardial effusion. Managed conservatively with multidisciplinary support, the patient's electrocardiographic abnormalities showed progressive normalization that correlated with clinical improvement of the oesophageal injury. Unfortunately, the patient succumbed to pulmonary and vascular complications 28 days later.</p><p><strong>Conclusion: </strong>Severe transmural esophagitis can produce dramatic, reversible cardiac manifestations through direct inflammatory extension. This case highlights the importance of recognizing non-cardiac causes of ST-segment elevation to avoid unnecessary, high-risk cardiac interventions in critically ill patients. Serial electrocardiograms may serve as a non-invasive marker reflecting the severity and progression of underlying oesophageal necrosis.</p><p><strong>Learning points: </strong><b>Mimicry of acute coronary syndrome</b> This case highlights that transmural oesophageal inflammation from alkaline ingestion can cause marked ST-segment elevation and significant troponin elevation (85.15 ng/ml) due to direct inflammatory extension to the adjacent myocardium, mimicking a myocardial infarction.<b>Anatomical clinical correlation</b> Understanding the posterior relation of the oesophagus to the left atrium and ventricle allows internists to recognize \"oesophageal-cardiac\" phenomena, potentially preventing high-risk, unnecessary cardiac catheterizations in critically ill patients with coagulopathy.<b>Prognostic monitoring</b> Serial electrocardiograms can serve as a non-invasive marker of transmural disease progression. In this case, the worsening of Zargar grades directly paralleled the evolution of electrocardiographic abnormalities.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006564"},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210603","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 Syncope to Stroke: Vascular Complications of Skull Base Paraganglioma.","authors":"Dhruva Govil, Batol Barodi, Shymaa Hammad, Michael Marshall","doi":"10.12890/2026_006587","DOIUrl":"10.12890/2026_006587","url":null,"abstract":"<p><strong>Background: </strong>Head and neck paragangliomas are typically slow-growing neuroendocrine tumours, but their proximity to major cervical vessels can result in significant neurovascular complications. Ischemic stroke is rarely described as a direct consequence and is more commonly attributed to catecholamine-mediated hypertension or vasospasm.</p><p><strong>Case description: </strong>A 48-year-old woman presented with recurrent syncope and was found to have multifocal acute ischemic infarcts on magnetic resonance imaging of the brain. Imaging revealed recurrent jugular foramen paraganglioma with extension along the internal carotid artery and compression of the internal jugular vein. The infarct pattern was embolic in distribution. Although hypertension and recent cocaine use were present, the close anatomic relationship between the tumour and major cervical vessels suggested tumour-related vascular compromise with secondary thromboembolism as a primary mechanism.</p><p><strong>Conclusion: </strong>This case highlights structural vascular involvement by head and neck paraganglioma as an underrecognized cause of embolic stroke. In patients with skull base tumours and multifocal infarcts, direct tumour-related vascular compromise should be considered to guide appropriate multidisciplinary management and reduce the risk of recurrent events.</p><p><strong>Learning points: </strong>Head and neck paragangliomas can cause ischemic stroke through direct vascular involvement, including carotid artery encasement and jugular vein compression, creating a structural source of thromboembolism.Multifocal infarcts across multiple vascular territories should prompt evaluation for embolic and structural causes, even in the presence of traditional risk factors such as hypertension or cocaine use.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 6","pages":"006587"},"PeriodicalIF":0.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210578","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":"Hepatic Myelopathy as a Rare but Reversible Neurological Complication Post Transjugular Intrahepatic Portosystemic Shunt (TIPS) Insertion in Liver Cirrhosis.","authors":"Angela Zhu, Warren Clements, Robb Wesselingh, Natasha Janko","doi":"10.12890/2026_006582","DOIUrl":"10.12890/2026_006582","url":null,"abstract":"<p><p>Hepatic myelopathy is a rare but underrecognized complication of chronic liver disease characterized by pure motor, symmetric and spastic paraparesis without sphincter involvement. We report the case of a 39-year-old female with Child Pugh A alcohol-related cirrhosis presenting with progressive spastic paraparesis 2 months after transjugular intrahepatic portosystemic shunt (TIPS) placement for recurrent oesophageal variceal bleed. TIPS occlusion achieved partial neurological recovery but significant functional improvement. She had no further presentations of decompensation with variceal bleeding or hepatic encephalopathy. Early recognition and multidisciplinary input are essential in preserving functional outcome, especially when liver transplant is not indicated.</p><p><strong>Learning points: </strong>The onset of symmetric, pure motor spastic paraparesis following a transjugular intrahepatic portosystemic shunt procedure in cirrhosis should prompt clinical suspicion for hepatic myelopathy.Hepatic myelopathy can be reversible with timely shunt occlusion/modification, especially when a liver transplant is not indicated.Recognizing liver cirrhosis as a systemic syndrome and adopting early multi-disciplinary input improve patient outcomes.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 5","pages":"006582"},"PeriodicalIF":0.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13166998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927824","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}