International Medical Case Reports Journal最新文献

{"title":"Density Spectral Array Patterns During Total Intravenous Anesthesia with Intravenous Lidocaine for Craniotomy: An Illustrative Two-Case Series.","authors":"Riyadh Firdaus, Jonathan Wiradinata, Lara Aristya, Bintang Pramodana, Arila Atalia","doi":"10.2147/IMCRJ.S645855","DOIUrl":"10.2147/IMCRJ.S645855","url":null,"abstract":"<p><strong>Purpose: </strong>Intravenous lidocaine is used as an adjuvant to total intravenous anesthesia (TIVA). To our knowledge, density spectral array (DSA) patterns during intravenous lidocaine administration in propofol-remifentanil TIVA for craniotomy have rarely been described. We present two illustrative cases for educational and hypothesis-generating purposes.</p><p><strong>Patients and methods: </strong>Two adults underwent craniotomy for tumor resection (left cerebellopontine angle, Case 1; suprasellar, Case 2) with effect-site target-controlled infusion of propofol (Schnider model) and remifentanil (Minto model) and a bilateral scalp block. After a 1.5 mg/kg bolus, lidocaine was infused at 1.5 mg/kg/hour (Case 1) or 2 mg/kg/hour (Case 2) and stopped 30 minutes before the end of surgery. Frontal bispectral index (BIS) and DSA were recorded throughout and interpreted qualitatively at the bedside and offline.</p><p><strong>Results: </strong>In Case 1, an alpha-delta pattern persisted during maintenance, including at the lowest targets used (propofol 1.8 mcg/mL, remifentanil 2.5 ng/mL; BIS 39-45). In Case 2, the DSA showed more pronounced delta dominance, attenuated alpha and beta activity, and intermittent burst suppression, which persisted when propofol was reduced to 1.5 mcg/mL. In both patients, transient beta-power increases were temporally associated with surgical stimulation; electromyographic contribution could not be excluded. No hemodynamic instability or adverse effect attributable to lidocaine was observed.</p><p><strong>Conclusion: </strong>This two-patient illustrative case series demonstrates differing DSA patterns during propofol-remifentanil TIVA with two intravenous lidocaine infusion regimens. Because the observations come from different patients with multiple clinical and anesthetic confounders, no dose-response relationship or causal effect of lidocaine can be established. These hypothesis-generating observations require evaluation in controlled studies.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"645855"},"PeriodicalIF":0.7,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216293","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":"Fibrolipomatous Hamartoma of the Median Nerve Misdiagnosed as a Palmar Space Abscess: A Case Report.","authors":"Ranjan Kumar Jha Snr, Gaurab Acharya, Arun Kumar Chaurasiya, Mohammed Ali Saghir","doi":"10.2147/IMCRJ.S634210","DOIUrl":"10.2147/IMCRJ.S634210","url":null,"abstract":"<p><strong>Background: </strong>Fibrolipomatous hamartoma (FLH), also categorized under lipomatosis of nerve, is a rare, is an uncommon benign fibrofatty lesion of the peripheral nerves that most commonly affects the median nerve. Its slow progression and atypical presentation often lead to misdiagnoses and improper surgical management.</p><p><strong>Case presentation: </strong>A 17-year-old female presented with a 5-year history of progressive left-hand swelling and paraesthesia and a 2-year history of pain and secondary reduction in grip strength. The mass was previously misdiagnosed as an acute mid-palmar space abscess, which resulted in an ineffective incision and drainage. Magnetic Resonance Imaging (MRI) revealed severe median nerve enlargement with pathognomonic \"coaxial cable\" (axial) and \"spaghetti-like\" (coronal) patterns. To prevent neurological deficits, a biopsy was avoided, and the patient underwent open carpal tunnel decompression. At 6-month postoperative follow-up, she demonstrated substantial symptomatic relief, restoration of pain-free grip and pinch strength, and no signs of neurological deterioration.</p><p><strong>Conclusion: </strong>FLH can mimic common inflammatory or infectious hand masses. Magnetic resonance imaging (MRI) provides highly characteristic features that allow a clinicoradiological diagnosis, generally obviating the need for an invasive biopsy. Carpal tunnel decompression may provide symptomatic relief in patients with compressive neuropathy while avoiding potentially injurious intraneural resection.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"634210"},"PeriodicalIF":0.7,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216305","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":"Extracorporeal Cardiopulmonary Resuscitation as a Bridge to Cardiac Transplantation in Refractory Cardiac Arrest Due to Fulminant Myocarditis: A Case Report.","authors":"Lajos Szentgyorgyi, Laura Roberts, Wesley Cheung, Jacquelyn Hooper, Flora Anne Jayne-Coupe, Hind Elmahdi, Vipin Mehta","doi":"10.2147/IMCRJ.S625131","DOIUrl":"10.2147/IMCRJ.S625131","url":null,"abstract":"<p><p>Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory cardiac arrest, although evidence for a survival benefit remains heterogeneous and appears highly dependent on patient selection and systems of care. We report the case of a previously healthy 36-year-old woman who presented with acute fulminant myocarditis and cardiogenic shock. Following an in-hospital cardiac arrest unresponsive to conventional cardiopulmonary resuscitation, bedside ECPR was initiated using peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to longer-term mechanical circulatory support with a biventricular assist device (BiVAD). After conversion to central BiVAD support, the patient was listed super-urgently and subsequently underwent successful donation-after-circulatory-death heart transplantation. She was discharged home neurologically intact and remains well five months after discharge. This case demonstrates that when deterioration is imminent and standard therapies have failed, ECPR may provide life-saving support while preparing for definitive mechanical circulatory support, even when most members of the clinical team lack ECPR experience. Timely leadership and coordinated multidisciplinary expertise were the key to achieving a successful outcome in this case.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"625131"},"PeriodicalIF":0.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181917","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":"Advanced Rheumatic Heart Disease Complicated by Pregnancy, Mitral Valve Disease, Pulmonary Hypertension, and Left Atrial Thrombus: A Multidisciplinary Case Report from Resource-Limited Settings.","authors":"Nouh Ismail Botan, Sadam Ismail Ahmed, Fatima Hachi Imaan, Kaltun Hassan Madar","doi":"10.2147/IMCRJ.S643597","DOIUrl":"https://doi.org/10.2147/IMCRJ.S643597","url":null,"abstract":"<p><strong>Introduction: </strong>Rheumatic heart disease (RHD) remains a leading cause of cardiovascular morbidity and mortality among pregnant women in resource-limited settings. Pregnancy induces significant hemodynamic changes that can decompensate pre-existing valvular heart disease, leading to life-threatening complications for both mother and fetus.</p><p><strong>Case presentation: </strong>A 27-year-old pregnant woman (gravida 6, para 5) at approximately 34-38 weeks presented with progressive shortness of breath, palpitations. Based on the modified World Health Organization (mWHO) classification, she was categorized as Class IV (extremely high risk) bilateral lower limb swelling, cough, fatigue, and reduced appetite. Cardiovascular examination revealed a systolic murmur, loud S1 and S2, with bilateral basal crepitations on respiratory examination. Echocardiography demonstrated an enlarged left atrium (5 cm), moderate mitral stenosis, mild mitral regurgitation, with fixed mitral valve leaflets, pulmonary hypertension, poor right ventricular function, a large left atrial thrombus, Labor occurred spontaneously while on low-molecular-weight heparin (LMWH). Mild pericardial effusion, and preserved left ventricular ejection fraction (58%). Laboratory investigations showed elevated CRP (48.8 mg/L), thrombocytopenia (platelets 99 ×10⁹/L), mild coagulation abnormalities (INR 1.5), and urinalysis findings consistent with hematuria and proteinuria. Electrocardiography revealed sinus tachycardia, left atrial enlargement, right ventricular hypertrophy pattern, incomplete right bundle branch block, and prolonged QTc interval. The patient received multidisciplinary care including furosemide, metoprolol, and enoxaparin. She delivered a 2.1 kg neonate with good Apgar scores.</p><p><strong>Discussion: </strong>This case illustrates the severe maternal and fetal risks associated with advanced RHD during pregnancy. The presence of a large left atrial thrombus in a pregnant woman poses significant thromboembolic and hemodynamic risks. Multidisciplinary management involving cardiology, obstetrics, anesthesia, and intensive care is essential for optimizing outcomes.</p><p><strong>Conclusion: </strong>This case highlights the critical importance of early recognition, strict adherence to CARE guidelines and multidisciplinary management, and the need for preventive strategies including primary prevention of rheumatic fever and secondary prophylaxis for RHD in resource-limited settings.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"643597"},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181911","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":"Extensive Aplasia Cutis Congenita with Calvarial Defect and Superior Sagittal Sinus Exposure in a Term Neonate: A Case Report of Successful Healing with Conservative Management.","authors":"Hussein Salad Yusuf, Abdirisak Ali Abukar, Mohamed Said Adan, Abdiaziz Siad Mohamed, Zakariye Yusuf Mohamed, Mustaf Abdi Ulusow, Mohamed Nur Ali, Farah Abdullahi Ismail, Yasir Khalif Ali, Abdisalam Mohamed Sh Abdilahi, Bisharo Omar Ali","doi":"10.2147/IMCRJ.S649235","DOIUrl":"https://doi.org/10.2147/IMCRJ.S649235","url":null,"abstract":"<p><strong>Background: </strong>Aplasia cutis congenita (ACC) is a rare congenital disorder characterized by localized absence of skin, most commonly affecting the scalp. Extensive lesions involving the calvarium and dura, particularly when the superior sagittal sinus is exposed, are uncommon and may be complicated by hemorrhage, infection, thrombosis, neurological injury, and mortality. Management may be conservative or surgical and must be individualized according to defect size and depth, the structures exposed, the clinical condition of the neonate, and the resources and expertise available.</p><p><strong>Case presentation: </strong>We report a term male neonate with an approximately 4 × 4 cm midline frontoparietal scalp defect involving the skin and calvarium, with exposure of the superior sagittal sinus and underlying tissue. Brain computed tomography demonstrated a large congenital midline frontoparietal calvarial defect without a major intracranial abnormality. The neonate was clinically stable and was managed conservatively with intravenous ampicillin (50 mg/kg/dose every 12 hours during the first week), topical nitrofurazone and rifampicin, and twice-daily sterile saline-moistened gauze dressings. The available record did not document the concentration/formulation of the topical agents, specific nutritional supplementation, or a standardized parental home-care training protocol. Serial wound assessments demonstrated progressive granulation and epithelialization without documented local wound infection or systemic sepsis. After eight months of continued wound care, the lesion showed near-complete epithelialization with mature scar formation, residual crusting, and cicatricial alopecia.</p><p><strong>Conclusion: </strong>This case demonstrates that conservative wound care can result in progressive closure in a clinically stable neonate with extensive ACC and calvarial defect with superior sagittal sinus exposure. The result should not be interpreted as evidence that conservative management is preferable to surgery in general. Instead, treatment should be individualized after assessment of bleeding, infection, depth of tissue loss, dural and venous-sinus exposure, neurological status, and the feasibility and risks of reconstruction. Close multidisciplinary monitoring and readiness to escalate to surgical coverage remain essential.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"649235"},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181914","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":"Pancreatic Tuberculosis Mimicking Pancreatic Cancer in a Young Immunocompetent Man: A Case Report and Literature Review.","authors":"Kourosh Kazemi, Neda Soleimani, Mehran Jafari, Fatemeh Pouraminaee, Zahra Dehghani, Sahand Mohammadzadeh, Saber Dehbanizadeh","doi":"10.2147/IMCRJ.S638587","DOIUrl":"https://doi.org/10.2147/IMCRJ.S638587","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic TB is extremely rare, even in endemic areas. Clinically and radiographically, it may resemble a malignant process. Herein, we present a case of pancreatic TB who underwent surgery with a preoperative diagnosis of pancreatic malignancy.</p><p><strong>Case presentation: </strong>A 34-year-old Afghan man presented with a one-year history of intermittent epigastric pain, accompanied by nausea and vomiting. Physical examination showed stable vital signs with mild epigastric tenderness. Laboratory examinations revealed mild anemia with mildly increased liver enzymes and lipase. The CA19-9 level in serum was mildly elevated, and the serologic test for HIV antibody was negative. An abdominal CT scan revealed a 57×30 mm multiloculated hypoattenuating mass-like lesion in the head of the pancreas with no evidence of biliary system dilation. As EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) was not available at our institution and the lesion was highly suspicious for pancreatic malignancy, the patient underwent Whipple resection. On macroscopic examination, a well-defined creamy soft mass with necrotic consistency was found in the head of the pancreas. Microscopic examination showed significant caseating granulomatous inflammation containing Langhans giant cells, and the Ziehl-Neelsen staining revealed a large number of acid-fast positive bacilli in favor of <i>Mycobacterium tuberculosis</i>. Anti-TB medicine was administered. No clinical or radiologic deficits were discovered during the 10-month follow-up visits.</p><p><strong>Conclusion: </strong>Pancreatic TB should be considered a differential diagnosis in pancreatic lesions, particularly in young patients from tuberculosis-endemic areas. Whenever feasible, preoperative EUS-guided FNA/FNB combined with microbiologic study may help avoid unnecessary invasive surgeries.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"638587"},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181834","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":"Accidental Bottle Cap Ingestion in an Adult in a Resource-Limited Setting: A Case Report.","authors":"Job Akora, Moses Gumira, Geoffrey Tabu","doi":"10.2147/IMCRJ.S629710","DOIUrl":"https://doi.org/10.2147/IMCRJ.S629710","url":null,"abstract":"<p><p>Foreign body ingestion in adults may become life-threatening depending on the site of impaction and the nature of the object. We report a 53-year-old man who accidentally ingested a bottle top while opening a pressurized reused beverage bottle with his teeth. He presented with drooling of saliva, dysphagia, throat pain, and foreign body sensation. Plain radiographs failed to identify the radiolucent foreign body but excluded airway involvement. Direct laryngoscopy identified the foreign body impacted at the cricopharyngeal opening, and successful removal was achieved using Magill forceps under general anesthesia. The patient recovered without complications. This report illustrates a pragmatic management approach for a directly visualized upper esophageal foreign body in a resource-limited setting.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"629710"},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181882","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":"Feasibility and Safety of Transcranial Focused Ultrasound on Language Impairment in a Patient with Autism Spectrum Disorder: A Case Report.","authors":"Chaoshan Yan, Guoli Zhu, Shan Liang, Yanpin Zhao, Weimin Chen, Qing Xia, Jing Jian, Zheng Wang, Beihua Zhang, Lijuan Ao","doi":"10.2147/IMCRJ.S653087","DOIUrl":"10.2147/IMCRJ.S653087","url":null,"abstract":"<p><strong>Background: </strong>Autism spectrum disorder (ASD) is defined by persistent difficulties with social communication and language, and a subset of children stay minimally verbal despite intensive interventions. The left amygdala and ventral-anterior superior temporal sulcus (STSva) form a key circuit for social-language integration, but how transcranial focused ultrasound (tFUS) might modulate in minimally verbal ASD has not been explored.</p><p><strong>Case presentation: </strong>An 11-year-old minimally verbal ASD boy received 4 weeks of sequential tFUS stimulation (0.5 MHz). The treatment targeted the left amygdala and STSva, five times per week. Outcome assessments included the Mandarin Clinical Evaluation of Language for Preschoolers' Core Scale (MCELP-CS), Autism Behavior Checklist (ABC), and functional near-infrared spectroscopy (fNIRS) at pre-tFUS, post-tFUS, and a 4-week follow-up. The boy tolerated the intervention well, with no adverse events. Significant improvements in key language skills (vocabulary naming +10%, sentence structure imitation +22%) and reduced ASD symptoms (ABC language -40%, social interaction -26%) were observed post-tFUS and sustained at follow-up. fNIRS confirmed altered cortical activation and reorganized functional connectivity in language-related brain regions.</p><p><strong>Conclusion: </strong>This single-case observational report describes acceptable tolerance to sequential tFUS targeting the left amygdala-STSva circuit in a minimally verbal child with ASD, alongside concomitant behavioural and neuroimaging changes. These preliminary observations provide descriptive, hypothesis-generating data for this circuit-directed intervention strategy and highlight the necessity of larger controlled trials to further evaluate its potential clinical utility.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"653087"},"PeriodicalIF":0.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165925","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":"Multiple Sclerosis During Pregnancy and the Postpartum Period: Diagnostic and Multidisciplinary Challenges in Two Cases.","authors":"Putri Nadya Syahidah, Setyorini Irianti, Johanes Cornelius Mose, Aih Cahyani, Nabilla Rhamdani","doi":"10.2147/IMCRJ.S614180","DOIUrl":"https://doi.org/10.2147/IMCRJ.S614180","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy may complicate the recognition and evaluation of new neurological symptoms suggestive of a central nervous system demyelinating disease. Diagnostic uncertainty may arise when clinical progression, neuroimaging findings, and supportive investigations are incomplete or inconclusive.</p><p><strong>Case presentation: </strong>We report two pregnant women with progressive focal neurological symptoms and radiological findings suggestive of a demyelinating disease. Case 1 involved a 27-year-old woman with a history of autoimmune spondyloarthritis who developed dizziness, gait instability, asymmetric weakness, paraesthesia, and neuropathic pain during pregnancy. She underwent preterm delivery, and postpartum MRI demonstrated juxtacortical hyperintense lesions. Case 2 involved a 24-year-old woman who developed progressive right-sided weakness, visual disturbances, and headache during pregnancy. MRI demonstrated multiple periventricular and subcortical hyperintense lesions. She subsequently experienced spontaneous preterm labor and neurological worsening during the early postpartum period. In both cases, the available clinical and radiological findings raised concern for a demyelinating disorder; however, incomplete diagnostic investigations precluded retrospective confirmation of a definitive multiple sclerosis phenotype.</p><p><strong>Conclusion: </strong>These two cases highlight the diagnostic and clinical challenges associated with neurological symptoms suggestive of demyelinating disease during pregnancy and the postpartum period. Careful interpretation of clinical and radiological findings, continued postpartum surveillance, individualized obstetric decision-making, and multidisciplinary collaboration are essential. These observations should not be interpreted as evidence of causal relationships between suspected demyelinating disease and adverse obstetric outcomes.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"614180"},"PeriodicalIF":0.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181839","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":"Severe Euglycemic Diabetic Ketoacidosis After Semaglutide-Associated Poor Intake Despite Empagliflozin Discontinuation: A Case Report.","authors":"Kianoush Niknam, Tahmoores Niknam","doi":"10.2147/IMCRJ.S650090","DOIUrl":"https://doi.org/10.2147/IMCRJ.S650090","url":null,"abstract":"<p><p>Euglycemic diabetic ketoacidosis (EDKA) may be overlooked when serum glucose is near normal. A 68-year-old woman with long-standing type 2 diabetes developed approximately three weeks of nausea, intermittent vomiting and diarrhea, and minimal oral intake after semaglutide initiation at 0.25 mg once weekly for four weeks followed by 0.5 mg once weekly. Patient and family medication reconciliation indicated that she had stopped empagliflozin, metformin, and pioglitazone approximately two weeks before presentation but continued semaglutide, with the last dose approximately eight days before admission. She presented with weakness, dyspnea, slowed speech, and disorientation. Initial testing showed glucose 132 mg/dL, venous pH 7.13, bicarbonate 9 mmol/L, anion gap 26 mmol/L, and beta-hydroxybutyrate 99.5 mg/dL. She improved with intravenous crystalloid, dextrose-containing fluids, insulin infusion, and electrolyte replacement. The temporal association is consistent with a clinically plausible contribution from semaglutide-associated gastrointestinal intolerance and carbohydrate depletion to EDKA despite reported prior empagliflozin discontinuation. Normal glucose should not delay ketone and acid-base testing when compatible symptoms and poor intake are present.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"19 ","pages":"650090"},"PeriodicalIF":0.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166563","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}