Journal of investigative medicine high impact case reports最新文献

{"title":"Pregnancy-Associated Cerebral Venous Thrombosis Presenting in the First Trimester: A Case Report.","authors":"Edy Quizhpe, Martha Villegas Jacho, Enrique Teran, Dario Carrera Quizhpe","doi":"10.1177/23247096261441725","DOIUrl":"10.1177/23247096261441725","url":null,"abstract":"<p><p>Cerebral venous thrombosis in pregnancy in the first trimester is a very rare condition but should not be confused with the clinical presentation of other common conditions in pregnancy such as pre-eclampsia. Although it is rare and difficult to diagnose, it is potentially serious and can increase maternal mortality. Diagnosis by imaging tests such as MRI and early treatment with heparin reduces maternal and perinatal morbidity and mortality. We present the case of a 39-year-old pregnant woman at 8 weeks' gestation who presented with early onset of severe headache and vomiting; MRI with angiography revealed a thrombosis in the right transverse venous sinus. Early treatment based on anticoagulation with heparin and maintenance with warfarin allowed a favorable response without neurological sequelae in the acute phase and at subsequent follow-up. The physiological state of hypercoagulability of pregnancy could increase the occurrence of pathologies such as cerebral venous thrombosis. We report this case as the only one published in the local literature.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261441725"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138345","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 Chest Pain Unmasks the Liver: Acute Pericarditis Leading to the Diagnosis of AIH-PBC Overlap Syndrome.","authors":"Ruba Habib, Noma Shri, Rayan Sabouh, Rouba Isshak, Hala Moussa, Aqsa Sorathia, Mina Alkomos, Walid Baddoura","doi":"10.1177/23247096261462280","DOIUrl":"10.1177/23247096261462280","url":null,"abstract":"<p><p>Autoimmune pericarditis is commonly idiopathic but may represent the initial manifestation of systemic autoimmune disease. Hepatic autoimmune disorders rarely present with primary cardiac involvement, and recognition of extrahepatic presentations is essential for early diagnosis and prevention of organ damage. Autoimmune hepatitis-primary biliary cholangitis (AIH-PBC) overlap syndrome is an uncommon entity characterized by combined hepatocellular and cholestatic immune-mediated injury. A previously healthy young woman presented with progressive pleuritic chest pain and dyspnea and was found to have a large pericardial effusion causing hemodynamic compromise requiring surgical drainage. Pericardial pathology demonstrated acute and chronic fibrinous pericarditis. Initial evaluation revealed elevated inflammatory markers and mild transaminitis with positive autoimmune serologies including antinuclear antibody and anti-smooth muscle antibody. Following clinical improvement, she developed recurrent pericarditis accompanied by worsening liver enzyme abnormalities. Liver biopsy demonstrated chronic active hepatitis with bile duct injury and bridging fibrosis, consistent with autoimmune hepatitis-primary biliary cholangitis overlap syndrome. Cardiac magnetic resonance imaging confirmed active pericardial inflammation without myocarditis. Immunosuppressive therapy with corticosteroids followed by azathioprine resulted in clinical stabilization. This case highlights autoimmune pericarditis as the presenting manifestation of AIH-PBC overlap syndrome and underscores the importance of evaluating unexplained pericarditis for systemic autoimmune disease. Early recognition of cardio-hepatic autoimmune overlap allows timely immunosuppressive therapy and may prevent progression to advanced hepatic fibrosis.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261462280"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302011","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":"Late-Presenting Myocardial Infarction With PCI and Impella Placement Complicated by Ventricular Septal Defect and Impella Malfunction.","authors":"Zaheen Hossain, Tai Metzger, Abdullah Jalal, James R Burmeister, Ismail Zazay, Mohamed Abdalaziz, Tucker Billups","doi":"10.1177/23247096261454418","DOIUrl":"10.1177/23247096261454418","url":null,"abstract":"<p><p>Post-myocardial infarction ventricular septal defect (VSD) is a rare but frequently fatal mechanical complication. We report a 67-year-old man who presented approximately 48 hours after symptom onset with dyspnea and was diagnosed with an ST-segment elevation myocardial infarction. He underwent emergent percutaneous coronary intervention supported by Impella placement but subsequently developed a large ventricular septal defect two days later, complicated by Impella malfunction. The patient ultimately underwent successful surgical repair. This case highlights the importance of maintaining a high index of suspicion for mechanical complications in late-presenting myocardial infarction, even after apparent stabilization with revascularization and mechanical circulatory support.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261454418"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981890","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":"Choreiform Movements and Pachymeningeal Enhancement in an Elderly Patient With Abnormal Blood Counts: A Case Report and Review of Literature.","authors":"Niloofar Bondariyan, Milan Patel, Pranati Shah, Daniel Park, Aren Dermarderosian, Saman Arfaie, Mahtab Mashayekhi, Khashayar Dashtipour, Mojtaba Akhtari","doi":"10.1177/23247096261478912","DOIUrl":"10.1177/23247096261478912","url":null,"abstract":"<p><p>Polycythemia vera (PV) is a clonal myeloproliferative neoplasm primarily caused by the JAK2V617F mutation, present in 95% of patients. It results in erythropoietin-independent hematopoietic proliferation, erythrocytosis, increased hematocrit (Hct), leukocytosis, thrombocytosis, and hyperviscosity, predisposing patients to thrombotic events and neurologic deficits, including erythromelalgia and pruritus. Neurologic manifestations can occur, such as transient ischemic attack (TIA) and stroke. We report an 83-year-old woman, PV patient who presented with chorea and magnetic resonance imaging (MRI) of her brain showed pachymeningeal enhancement (dural-arachnoid enhancement); this radiological finding is most commonly described in intracranial hypotension, autoimmune conditions, infection, and neoplastic processes and has not been reported in PV. Laboratory findings included complete blood count (CBC) showed severe erythrocytosis, moderate leukocytosis with moderate, mild thrombocytosis; bone marrow (BM) aspiration and biopsy showed hypercellular BM and marked megakaryocytic hyperplasia; and positive JAK2V617F mutation with 80% JAK2 DNA, suggestive of PV as the underlying cause. The patient underwent phlebotomy and was started on Aspirin. Following treatment, she showed dramatic improvement in choreiform movements. Hydroxyurea 500 mg three times daily was subsequently added, leading to complete hematologic response and resolution of pachymeningeal thickening on follow up MRI. This case suggested association between polycythemia vera and choreiform movements and a possible mechanism is proposed.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261478912"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766436","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":"Right Atrial Non-Valvular Papillary Fibroelastoma Causing Paradoxical Embolic Stroke Through an Ostium Secundum Atrial Septal Defect: A Case Report.","authors":"Ivan Felipe Manrique Osorio, Martin Rebolledo, Karen Alvarez, Wilson Bohorquez","doi":"10.1177/23247096261452104","DOIUrl":"10.1177/23247096261452104","url":null,"abstract":"<p><p>Papillary fibroelastoma (PFE) is a rare benign cardiac tumor, usually left-sided and valvular. Right-sided, non-valvular PFEs are uncommon, and systemic embolization from these lesions is particularly rare, typically requiring an interatrial shunt. We report a surgically confirmed right-atrial, non-valvular PFE presenting with paradoxical embolic stroke through an ostium secundum atrial septal defect (ASD). A 72-year-old woman with recurrent ischemic cerebrovascular events was admitted with an acute posterior circulation stroke. Transthoracic echocardiography was nondiagnostic. Transesophageal echocardiography revealed a 13 x 14 mm highly mobile mass attached to the free wall of the right atrium and an ostium secundum ASD (about 9-10 mm) with bidirectional shunting. Surgical resection of the mass with concomitant ASD closure was performed 14 days after the index stroke. Gross inspection suggested a frond-like tumor; histopathology confirmed PFE. Postoperative recovery was uneventful. Anticoagulation was resumed for a new distal deep-vein thrombosis, and no further embolic events have occurred during follow-up. This case illustrates an unusual mechanism of systemic embolism from a right-sided, non-valvular PFE via paradoxical embolization through an ASD. It emphasizes the limitations of transthoracic echocardiography in detecting small or atypically located PFEs and supports transesophageal echocardiography as the modality of choice when clinical suspicion persists. In symptomatic patients or after embolism, surgical excision, particularly with simultaneous closure of right-to-left shunts, should be considered to minimize recurrence risk. Clinicians should include PFE in the differential diagnosis of recurrent cryptogenic stroke and actively search for interatrial shunts when right-sided tumors are suspected.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261452104"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941688","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":"Guillain-Barré Syndrome Presenting With New-Onset Heart Failure.","authors":"Priya Ramcharan, Arun Katwaroo, Matthew Maharaj, Satesh Ramkesson, Chenelle Khan, Valmiki Seecheran, Rajeev Seecheran, Nicholas Maraj, Naveen Anand Seecheran","doi":"10.1177/23247096261452878","DOIUrl":"10.1177/23247096261452878","url":null,"abstract":"<p><p>Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy that can involve the autonomic nervous system, leading to hemodynamic instability. While transient arrhythmias are typically observed, the occurrence of acute heart failure (AHF) within the GBS spectrum is exceedingly rare. We report the case of a previously healthy 61-year-old Caribbean South-Asian male who developed intractable left ventricular dysfunction (LVD) and cardiogenic shock (CS) after returning from a one-month vacation in Canada, from which he ultimately succumbed despite aggressive guideline-directed medical therapy (GDMT) and high-dose intravenous immunoglobulin (IVIG). Notably, the patient's younger brother predeceased him (25 years) from a suspected GBS-related complication, while his niece also survived a protracted GBS-hospitalization when she was very young (4 years). This case highlights that acute cardiomyopathy (CMP) may be a rare but catastrophic sequela of GBS, underscoring the importance of early recognition and intensive supportive care. The robust familial link also suggests a potential genetic susceptibility to GBS, warranting heightened vigilance and further research.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261452878"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973060","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":"Occupational Anaphylaxis to Piperacillin-Tazobactam in a Nurse: A Case Report.","authors":"Guedes Catarina, Van-Beveren Patrícia, Manso-Preto Leonor, Alves Margarida, Cardoso-Lopes João, Todo-Bom A, Faria E","doi":"10.1177/23247096261450068","DOIUrl":"10.1177/23247096261450068","url":null,"abstract":"<p><p>Piperacillin-tazobactam is a widely used β-lactam antibiotic, yet occupational systemic anaphylaxis remains exceptionally rare. We report the case of a 26-year-old female nurse with persistent atopic dermatitis and previous history of allergic contact dermatitis to nickel and cobalt, who developed occupational anaphylaxis while preparing intravenous cefuroxime and piperacillin-tazobactam. She presented with acute erythematous papules, rhinorrhea, wheezing, dyspnea, and tachycardia, requiring treatment with intramuscular epinephrine, intravenous clemastine, and hydrocortisone, with complete clinical resolution. She later tolerated cefuroxime handling but developed a generalized rash following accidental skin contact with piperacillin-tazobactam powder. No cofactors were identified, and no reactions occurred outside the workplace. Skin prick testing was performed and elicited an exuberant positive response, with a wheal >20 mm, marked erythema, pruritus, and satellite vesicles after 15 minutes. Additional work-up showed positive specific IgE to penicilloyl G and amoxicillin, with negative latex and formaldehyde testing and normal baseline tryptase. This case supports piperacillin-tazobactam as a potential occupational allergen capable of inducing severe IgE-mediated reactions through non-therapeutic exposure, possibly via inhalation or skin contact during drug reconstitution. Early recognition, diagnostic confirmation, exposure avoidance, and workplace adjustments are essential to prevent recurrent reactions and reduce the risk of occupational disability. In selected cases transfer to a low-exposure work environment may be required. This case reinforces that non-therapeutic occupational exposure to piperacillin-tazobactam can lead to life-threatening IgE-mediated anaphylaxis, highlighting the need for increased awareness and structured preventive strategies in healthcare settings.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261450068"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930507","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":"Dynamic LVOT Obstruction as a Cause of Hemodynamic Instability in Takotsubo Syndrome.","authors":"Simran Tanna, Gurleen Sangha, Sohrab Singh, Nishant Patel, Umer Suleman, Jonathan Kutcher, Srijani Thannir, Sabah Siddiqui","doi":"10.1177/23247096261475113","DOIUrl":"10.1177/23247096261475113","url":null,"abstract":"<p><p>Takotsubo syndrome (TTS) frequently presents with chest pain, ST-segment elevation, and troponin elevation, closely mimicking acute coronary syndrome, and can be complicated by acute heart failure and cardiogenic shock. In a subset of patients, dynamic left ventricular outflow tract obstruction (LVOTO) with systolic anterior motion (SAM) of the mitral valve contributes to hemodynamic instability and requires a distinct therapeutic approach. We report a 79-year-old woman admitted for evaluation of biliary and pancreatic ductal dilation who developed acute chest pain followed by dizziness and hypotension during hospitalization. Electrocardiography demonstrated anterolateral ST-segment elevations, and HS troponin I peaked at 7,594 ng/L. Emergent coronary angiography revealed mild, non-obstructive coronary artery disease, while left ventriculography demonstrated apical akinesis with basal hyperkinesis consistent with TTS. Persistent hypotension despite intravenous fluids prompted bedside echocardiography, which demonstrated severe left ventricular systolic dysfunction with basal hypercontractility and SAM. Transthoracic echocardiography confirmed severe dynamic LVOTO (peak gradient 126 mmHg) with moderate mitral regurgitation and reduced ejection fraction (25%-30%). Phenylephrine was initiated with prompt improvement in blood pressure and symptoms, while inotropes and afterload-reducing agents were avoided. With cautious volume resuscitation and beta-blockade after stabilization, serial echocardiography demonstrated reduction in LVOT gradient and improvement in mitral regurgitation. This case highlights the importance of early echocardiography in hypotensive patients with suspected TTS, the need for mechanism-directed management when dynamic LVOTO is present, and suggests that the distribution of regional wall motion abnormalities may influence the development of obstructive physiology.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261475113"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630659","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":"Epilepsia Partialis Continua in an Adolescent: A Case of Diagnostic Overshadowing.","authors":"Ryan Brogan","doi":"10.1177/23247096261470722","DOIUrl":"10.1177/23247096261470722","url":null,"abstract":"<p><p>Epilepsia partialis continua is an uncommon form of focal status epilepticus characterized by continuous focal motor activity with preserved awareness. In adolescents with psychiatric comorbidity, these movements may be mistaken for functional or compulsive behavior, a phenomenon that may reflect diagnostic overshadowing, the misattribution of neurological or medical symptoms to a preexisting psychiatric condition. A 15-year-old boy with anxiety disorder, obsessive compulsive disorder, and panic disorder presented with a two week history of persistent right toe and foot tapping that spread proximally and became painful. His family reported that the movements continued during sleep, although inpatient observation showed that they occasionally paused or disappeared. This inconsistency contributed to an early impression of a psychogenic process and led to the deferral of neuroimaging. Continuous video EEG subsequently demonstrated frequent, rapidly recurring epileptiform discharges over the left central region that corresponded to the right foot movements, confirming epilepsia partialis continua. Treatment with lacosamide and clobazam led to complete resolution of the movements and pain within 24 hours. Subsequent brain MRI was unremarkable, and symptoms remained controlled on follow up. This case illustrates how psychiatric history can shape diagnostic reasoning and delay recognition of epilepsia partialis continua. Persistent focal motor activity, even when intermittently suppressible or behaviorally ambiguous, should prompt early consideration of this diagnosis and escalation to prolonged video EEG when routine evaluation is inconclusive, enabling accurate diagnosis and effective seizure control.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261470722"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447457","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>Legionella</i> Myocarditis with Reversible Left Ventricular Dysfunction in a Patient Receiving Adalimumab: A Case Report.","authors":"Alhasan Saleh Alzubi, Mohamed Shelig, Yasser Hegazy, Zakaria Alagha, Abdelrahman Farag Abdelwahed, Shaden Daloub, Ashraf M Elghul, Amro Al-Astal","doi":"10.1177/23247096261490386","DOIUrl":"https://doi.org/10.1177/23247096261490386","url":null,"abstract":"<p><p><i>Legionella pneumophila</i> is a well-recognized cause of community-acquired pneumonia, but its capacity to cause extrapulmonary complications, including myocarditis, remains underappreciated. Myocarditis is among the rarest and most serious cardiac manifestations of <i>Legionella</i> infection and may be underdiagnosed in critically ill patients, where troponin elevations are often attributed to sepsis-related myocardial injury. We report the case of a 51-year-old woman with diabetes mellitus, ulcerative colitis managed with adalimumab (a tumor necrosis factor-α inhibitor), and a significant smoking history who presented to the emergency department after being found unresponsive. She was febrile, tachycardic, and in respiratory distress, with laboratory findings significant for markedly elevated troponin (7,377 ng/L), creatine kinase (10,561 U/L), and procalcitonin (27 ng/mL). Echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of less than 15%. A urine antigen test confirmed <i>Legionella</i> pneumonia. Hemodynamic assessment using the Fick method excluded cardiogenic shock, and left heart catheterization demonstrated no obstructive coronary artery disease. Following a 14-day course of levofloxacin along with supportive care, her cardiac function recovered completely, with a follow-up ejection fraction of 71%. This case highlights the potential for <i>Legionella</i> infection to cause fulminant yet fully reversible myocarditis and underscores the role of TNF-α inhibitor therapy as a predisposing factor for severe <i>Legionella</i> disease. Clinicians should maintain a high index of suspicion for myocarditis in patients with <i>Legionella</i> pneumonia who present with unexplained troponin elevation and new systolic dysfunction, as early recognition and targeted antimicrobial therapy can lead to complete cardiac recovery.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261490386"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001918","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}