European journal of case reports in internal medicine最新文献

{"title":"An XY Female.","authors":"Marwa Al-Qudheeby, Dhari Alharbi, Layal Alqaysi, Fatemah Alshaer, Lulwa Al-Enezi","doi":"10.12890/2025_005277","DOIUrl":"https://doi.org/10.12890/2025_005277","url":null,"abstract":"<p><strong>Background: </strong>Primary amenorrhoea (PA) is defined as the lack of menstruation at age 13 years in the absence of normal growth and secondary sexual characteristics, or lack of menstruation at age 15 years in the setting of normal growth and secondary sexual characteristics. Most underlying causes of PA can be classified into gonadal, anatomic, endocrine and systemic causes. Disorders of sexual development (DSD) are a rare, yet challenging aetiology.</p><p><strong>Case description: </strong>We present a 24-year-old, previously healthy female, who complained of PA and absent breast development. The patient denied any other symptoms. The physical examination revealed a tall girl, with infantile breasts and unambiguous female external genitalia, with no abnormalities. Laboratory tests showed hypogonadotropic hypogonadism (HH), undetectable anti Müllerian hormone (AMH), present Müllerian structures and absent ovaries in the pelvic magnetic resonance imaging (MRI), with a 46,XY karyotype. The abdominal and pelvic laparoscopy confirmed the presence of Müllerian structures, with no evidence of gonadal tissues. A diagnosis of early testicular regression syndrome (ETRS) was given. Hormonal replacement therapy (HRT) was started and escalated thereafter, resulting in regular menses, breast development and patient satisfaction.</p><p><strong>Conclusion: </strong>PA in a 46,XY female is a challenging disorder. Although several differential diagnoses are considered, the unique clinical, hormonal, radiological and cytogenic findings are helpful in suggesting the diagnosis of ETRS.</p><p><strong>Learning points: </strong>Primary amenorrhoea can be caused by defects at various levels.The disorders of sexual development are important, yet less frequent, causes of primary amenorrhoea.The successful management of primary amenorrhoea relies on a multidisciplinary approach.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005277"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983906","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":"Malignancy can Present as Acute Liver Failure - A Case Report of B-Cell Lymphoma with Acute Liver Failure as its First Presentation.","authors":"Catarina Melita, Joaquim Tinoco, Rita Theias Manso, Liliana Antunes, Mónica Palma Anselmo, Paulo Telles de Freitas","doi":"10.12890/2025_005236","DOIUrl":"https://doi.org/10.12890/2025_005236","url":null,"abstract":"<p><p>Malignant infiltration of the liver is a rare cause of acute liver failure and is associated with an exceedingly high mortality rate. We describe the case of an elderly woman presenting with fulminant hepatitis and simultaneous type B lactic acidosis, with near-normal imaging findings, who was later demonstrated to have non-Hodgkin lymphoma. The presence of acute liver failure, hepatomegaly, markedly elevated lactate dehydrogenase and/or lactic acidosis should raise suspicion for lymphoma infiltration of the liver and prompt liver biopsy early in the course of disease. We hope to raise awareness for this uncommon and elusive presentation of lymphoma, in the hope that it will help achieve earlier diagnoses and improvements in patient survival.</p><p><strong>Learning points: </strong>Lymphoma presenting as fulminant hepatitis is rare and frequently fatal.Malignant infiltration of the liver should be suspected in cases of acute liver failure, particularly when no clear aetiology is present, and liver biopsy should be performed promptly.The internist should be aware of lymphoma as a potential cause of type B, non-hypoxemic lactic acidosis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"005236"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959845","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":"Ultrasound and Magnetic Resonance Imaging Features of Eccrine Spiradenoma of the Scrotum.","authors":"Mohammed Ayesh Zayed, Mohamed Sherif El-Sharkawy, Mohamed A Bedewi, Bader A Alhariqi, Husain Alturkistani, Kholoud J Sandougah","doi":"10.12890/2025_005283","DOIUrl":"https://doi.org/10.12890/2025_005283","url":null,"abstract":"<p><p>Eccrine spiradenoma is a rare benign dermal tumor which is usually diagnosed after excision by histopathological results. A few case reports described imaging by ultrasound only. We describe additional magnetic resonance imaging features of scrotal eccrine spiradenoma by different sequences. We report the case of a 67-year-old man presented with a mildly painful intrascrotal swelling that had been increasing in size. The lesion was evaluated with ultrasound and magnetic resonance imaging, and the diagnosis of eccrine spiradenoma was confirmed by histopathology. The patient underwent surgical removal of the lesion. The patient recovered well and was followed up for 12 months. Scrotal eccrine spiradenoma is a rare tumor and little is known about its imaging features. The combination of ultrasound and magnetic resonance imaging features may help radiologists to strongly suspect the diagnosis before histopathological confirmation.</p><p><strong>Learning points: </strong>Scrotal eccrine spiradenoma is a rare tumor and little is known about its imaging features.The combination of ultrasound and magnetic resonance imaging features may help radiologists to strongly suspect its diagnosis before histopathological confirmation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"005283"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975688","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":"Mottling as an Early Sign of Euglycemic Ketoacidosis Induced by SGLT-2 Inhibitors.","authors":"Besard Memeti, Felix Brombacher, Ludwig Perger, Stefan Russmann","doi":"10.12890/2025_005210","DOIUrl":"https://doi.org/10.12890/2025_005210","url":null,"abstract":"<p><p>Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have shown benefits in managing heart failure, renal insufficiency and type 2 diabetes, but euglycemic ketoacidosis, while rare, has been reported in several patients on those medications. Therefore, their potential for inducing ketoacidosis, even in the presence of normal glucose levels, requires careful monitoring. We describe the case of a 78-year-old woman with type 2 diabetes treated with the SGLT-2 inhibitor dapagliflozin and the biguanide metformin, who presented after several days of reduced food and fluid intake due to nausea and diarrhoea to the emergency department. A few hours after admission to the medical ward with a working diagnosis of infectious gastroenteritis her condition deteriorated, and mottling served as an early sign of life-threatening euglycemic ketoacidosis. The mottling score increased in parallel with the National Early Warning Score (NEWS). She was treated with intravenous fluids, continuous insulin therapy and supportive measures, resulting in rapid clinical improvement. This report highlights the importance of early recognition to prevent serious complications and underscores that mottling might be a valuable early sign in addition to classical tools such as the NEWS. Although rare, euglycemic ketoacidosis can be precipitated by factors such as starvation, dehydration or infections in patients taking SGLT-2 inhibitors. The risk might be higher in individuals on SGLT-2 inhibitors and metformin. Timely intervention and metabolic correction are essential for improving outcomes in these patients, particularly when they present with atypical symptoms.</p><p><strong>Learning points: </strong>Mottling can serve as an early clinical indicator of euglycemic ketoacidosis (EKA) in patients treated with sodium-glucose co-transporter-2 (SGLT-2) inhibitors, even in the absence of circulatory shock, highlighting the importance of timely detection and intervention.Factors such as starvation, dehydration or infections can precipitate EKA in patients using SGLT-2 inhibitors, emphasising the need for careful monitoring in at-risk populations.Discontinuation of SGLT-2 inhibitors, rapid metabolic correction using fluids and insulin and avoidance of unnecessary antibiotics are essential for effective management and recovery from EKA.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"005210"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974327","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":"When the Heart and Brain Collide: A Case of Malignant Middle Coronary Artery Infarction and Cardiac Arrhythmias Linked to Right Insular Cortex Dysfunction.","authors":"Fnu Arty, Shreya Devarashetty, Sai Rakshith Gadameedi, Axle Untalan, Mahrukh Khan, Shazia Shah","doi":"10.12890/2025_005312","DOIUrl":"https://doi.org/10.12890/2025_005312","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a common cause of insular cortex injury, and it is associated with a rare complication of cardiac arrhythmia, which can be life-threatening. Here we present a case of this complication.</p><p><strong>Case presentation: </strong>An 88-year-old female presented to the emergency department for acute and severe abdominal pain, non-radiating, associated with 3 days of watery diarrhea with no other symptoms. The patient was adequately resuscitated and admitted for gastroenteritis. During the hospitalization, the patient had episodic hypertension requiring as needed hydralazine use. The patient was doing well until she had an episode of syncope. She was vitally stable, and examination was again unremarkable. One hour later, the patient developed slurred speech and left-sided weakness. CT angiography (CTA) revealed acute occlusion on chronic stenosis of the M2 branch corresponding to insular cortex on the right, and mild stenosis of the proximal M1 segment of the right middle cerebral artery was noted. The patient went on to become hemodynamically unstable with hypotension and bradycardia and eventually underwent cardiac arrest. The patient achieved the return of spontaneous circulation but coded again and did not survive the event.</p><p><strong>Conclusion: </strong>Stroke affecting the insular cortex can cause a variety of cardiac complications, including arrhythmia. Early recognition and prompt management of cardiac arrhythmia in patients with insular cortex stroke is crucial to prevent life-threatening complications. CTA with contrast should be carefully considered after weighing the potential benefits and risks of the procedure, as well as the implementation of strategies to minimize the risk of CIN. Further research is needed to understand mechanisms underlying these complications and to develop more effective treatments.</p><p><strong>Learning points: </strong>The insular cortex is crucial for autonomic regulation, and strokes affecting this region are associated with deadly arrhythmias.Early cardiac monitoring, especially within the first 2-3 days after a stroke, is critical for avoiding life-threatening complications.Early stroke therapies like thrombolysis and thrombectomy with intensive post-stroke care improves recovery prospects dramatically.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"005312"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984106","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":"Recurrent Anemia Due To Mucosal Prolapse Syndrome.","authors":"Tetsu Sakamoto, Takanobu Hirosawa, Taro Shimizu","doi":"10.12890/2025_005314","DOIUrl":"https://doi.org/10.12890/2025_005314","url":null,"abstract":"<p><p>Mucosal prolapse syndrome is a rare group of benign disorders mainly in the rectum. It often causes rectal bleeding, abdominal pain, and anaemia. We report a case of severe anaemia due to mucosal prolapse syndrome requiring blood transfusion. A 36-year-old man was referred for further evaluation of recurrent iron deficiency anaemia. Initial examinations, including esophagogastroduodenoscopy, colonoscopy, and capsule endoscopy, revealed no significant abnormalities other than rectal mucosal prolapse syndrome without notable bleeding. Nine months later, despite oral iron therapy, the patient developed bloody stools and severe anaemia (haemoglobin 6.2 g/dl), requiring a transfusion. Colonoscopy showed an enlarged mucosal prolapse, which was strongly suspected as the cause of the anaemia, leading to a transanal lumpectomy. Postoperatively, the patient has remained symptom-free, with no recurrence of anaemia or bloody stools. While mucosal prolapse syndrome is an rare condition, clinicians should remain vigilant about its potential to cause severe anaemia requiring blood transfusion.</p><p><strong>Learning points: </strong>Mucosal prolapse syndrome (MPS) is a benign group of conditions associated with mucosal prolapse and can appear in a variety of forms, mainly in the rectum.Although MPS is rare, clinicians should remain vigilant as it can lead to severe anaemia requiring blood transfusions.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"005314"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990542","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":"<i>Aspergillus</i> Suppurative Thyroiditis in the Setting of Hypogammaglobulinaemia.","authors":"Thuy Hao Nguyen, Mahima Upadhyay, Kaitlin Liroff, Philip McDonald","doi":"10.12890/2025_005296","DOIUrl":"https://doi.org/10.12890/2025_005296","url":null,"abstract":"<p><p>Thyroiditis is a condition characterised by the inflammation of the thyroid gland. Most cases of suppurative thyroiditis are caused by aerobic bacteria and present acute onset of symptoms. Hypogammaglobulinaemia associated with suppurative thyroiditis is extremely rare. This case relates to a diagnosis of <i>Aspergillus</i> suppurative thyroiditis in 78-year-old female patient in a setting of hypogammaglobulinaemia. The patient initially presented with dyspnoea following a recent diagnosis of chronic obstructive pulmonary disease. She developed worsening thyroid pain and swelling, and lab results confirmed hyperthyroidism. Imaging revealed a multinodular goitre, and fine-needle aspiration confirmed <i>Aspergillus fumigatus</i>. After discontinuing antibiotics, voriconazole was started. Due to immunologic workup showing low IgG, intravenous immunoglobulin was administered. Symptoms improved after a 12-week course. This case highlights the importance including differential diagnosis of fungal infection in patients present with acute suppurative thyroiditis and significance of conducting a comprehensive assessment for underlying immunodeficiency.</p><p><strong>Learning points: </strong>Although rare, fungal pathogens such as <i>Aspergillus</i> should be considered in patients with acute neck pain, swelling and signs of systemic infection, particularly in immunocompromised individuals.For infections caused by uncommon pathogens, immunology deficiency evaluation is important.Given the high mortality associated with <i>Aspergillus</i> thyroiditis, early identification and prompt treatment are essential to improved patient outcomes.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"005296"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959973","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":"Hyperinflammation and Blindness. Screening for ROSAH Syndrome.","authors":"Fernando Tornero-Romero, Rosa Sánchez-Hernandez, Lara Cantero-Del Olmo, Andres Saravia-Moya, Marina Gonzalez de Rivera-Utrera, Ana Isabel Sánchez-Barbero, Ester Carreño-Salas","doi":"10.12890/2025_004989","DOIUrl":"https://doi.org/10.12890/2025_004989","url":null,"abstract":"<p><p>In 2019, ROSAH syndrome (retinal dystrophy, optic nerve oedema, splenomegaly, anhidrosis, and headache) was identified in five families, attributed to a mutation in the <i>ALPK1</i> gene. Subsequently, in 2022, it was classified within the spectrum of autoinflammatory diseases with multisystemic involvement. Evidence has demonstrated that this genetic mutation induces hyperactivation of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-KB) inflammasome pathway, and the clinical phenotype of 27 patients has been documented. We present the case of a patient who experienced an acute presentation characterized by anaemia, thrombocytopenia, and mild renal and hepatic dysfunction. Furthermore, this article underscores the remarkable therapeutic efficacy of interleukin 6 (IL-6) blockade and provides a detailed account of the clinical progression of the various organs and systems affected by the disease.</p><p><strong>Learning points: </strong>ROSAH is a syndrome that includes retinal dystrophy, optic nerve oedema, splenomegaly, anhidrosis and headache.So far it has only been reported in five families who have a mutation in the <i>ALPK1</i> gene.Patients can improve dramatically on treatment with an interleukin 6 inhibitor.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"004989"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959893","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":"Inhaled Iloprost for Digital Necrosis in Systemic Sclerosis - An Effective Alternative.","authors":"Jaouad Yousfi, Soukaina Alami Idrissi, Fatima Dakir, Zineb Bott, Chadyne Taouil, Mouna Zahlane, Lamiaa Essaadouni","doi":"10.12890/2025_004913","DOIUrl":"https://doi.org/10.12890/2025_004913","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular issues in systemic sclerosis (SSc), notably Raynaud's phenomenon, can lead to digital ulcers (DU) and necrosis, causing pain and infections. Intravenous prostacyclin (iloprost) is used for established DUs. We report a case where severe Raynaud's phenomenon revealed SSc sine scleroderma, which improved with inhaled iloprost.</p><p><strong>Case description: </strong>A 52-year-old former smoker with protein C deficiency, on anticoagulation since 2016 for a previous deep vein thrombosis, presented with severe Raynaud's phenomenon and pulp necrosis of the third right finger. The capillaroscopy revealed megacapillaries suggestive of a connective tissue disease, and antinuclear antibodies were positive for centromere fluorescence. Doppler ultrasound and cardiopulmonary assessments were normal. The patient underwent necrosectomy but had ischemic pain and cyanosis post-surgery. Inhaled iloprost (2 ampoules of 10 mg/10 ml daily in 3 cycles of 5 days) led to significant clinical improvement.</p><p><strong>Conclusion: </strong>Inhaled iloprost could be an effective and better-tolerated alternative to intravenous iloprost for treating SSc DUs. Further studies are needed to confirm this potential.</p><p><strong>Learning points: </strong>This case report shows the efficacy of inhaled prostacyclin in the treatment of digital ulcers in systemic sclerosis as an equally effective, better tolerated, and safer alternative to the usual intravenous route.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"004913"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973303","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":"Apixaban Failure in A Post-Bariatric Surgery Female Patient with Thoracic Aortic Thrombus Secondary to Covid-19.","authors":"Joshua Hermiz, Nikolas Kenaya, Quang Dat Ha, Masahiro Yabe, Umesh Bhagat, Christian Toquica Gahona","doi":"10.12890/2025_005254","DOIUrl":"https://doi.org/10.12890/2025_005254","url":null,"abstract":"<p><p>A floating thrombus in the thoracic aorta represents a rare vascular condition frequently associated with morbidity and mortality. There is no standardised management approach, but options potentially include anticoagulation therapy, surgical intervention or a combination of these. Clinicians are increasingly selecting direct oral anticoagulants (DOACs) due to predictable pharmacokinetics. Here, we present a 37-year-old female with a history of Roux-en-Y gastric bypass surgery for obesity, who was found to have an incidental floating thrombus in the thoracic aorta during evaluation for generalised weakness and altered mentation following a recent COVID-19 infection. The patient was initially treated with intravenous heparin and subsequently transitioned to apixaban. Despite medication adherence, she presented two weeks later with worsening mental status and bilateral leg swelling. Repeat imaging revealed rupture of the thrombus, leading to right renal and bowel infarctions. The failure of anticoagulation was attributed to malabsorption secondary to her bariatric surgery. Despite aggressive interventions, the patient ultimately developed multisystem organ failure and succumbed to her illness. Literature suggests that DOACs may be less effective in post-bariatric patients due to altered pharmacokinetics. Due to the absence of clinical guidelines for post-bariatric patients, we recommend full-dose anticoagulation with warfarin, a vitamin K antagonist, to enable therapeutic international normalised ratio (INR) monitoring and necessary dose adjustments. DOACs are less effective in this population, particularly in hypercoagulable states, and the lack of monitoring increases the risk of treatment failure and subsequent life-threatening complications. This case report is of apixaban treatment failure in a female patient with a Roux-en-Y gastric bypass.</p><p><strong>Learning points: </strong>There is no established management of floating aortic mural thrombus detected by computed tomography.The efficacy of oral anticoagulants after bariatric surgery is uncertain.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 4","pages":"005254"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989025","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}