Archive of clinical cases最新文献

{"title":"A unique case of sepsis-triggered reverse Takotsubo cardiomyopathy resulting in cardiogenic shock.","authors":"Andrei-Antonio Caracioni, Sami Mouritane, Sachin Singh, Ryan Farley, Amr Moussa, Ameli Yates, Igor Knez, Markus Mach, Guenther Laufer, Martin Andreas, Theodore Schreiber, Nishtha Sareen","doi":"10.22551/2025.49.1204.10328","DOIUrl":"10.22551/2025.49.1204.10328","url":null,"abstract":"<p><p>Reverse Takotsubo syndrome (rTTS) is an acute cardiomyopathy characterized by prominent dysfunction in the basilar and mid-ventricular segments with apical hyperkinesis, often triggered by excessive stress hormone release. Sepsis can exacerbate this process. We present a unique case of a 27-year-old male with no chronic illnesses who developed sepsis-triggered rTTS resulting in cardiogenic shock. The initial presentation included nausea, vomiting, tachypnea, and fluctuating blood pressure. Laboratory findings revealed elevated cardiac and inflammatory markers, metabolic acidosis, and bacteremia caused by <i>Staphylococcus aureus</i>. Echocardiography showed an initial left ventricular ejection fraction (LVEF) of 45% with basal mid-ventricular hypokinesia and apical hyperkinesis, characteristic of rTTS. Coronary angiography excluded obstructive coronary artery disease. The patient developed cardiogenic shock (SCAI Stage D) requiring vasopressors and mechanical circulatory support with an Impella CP® device. Complications included acute kidney injury requiring renal replacement therapy and posterior reversible encephalopathy syndrome (PRES). With targeted antimicrobial therapy and supportive care, the patient's LVEF improved to 60-65%, and he made a significant clinical recovery. This case highlights the importance of recognizing sepsis as a trigger for rTTS and the potential for full recovery with prompt, aggressive management, including mechanical circulatory support.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 4","pages":"140-147"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12581186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446608","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":"Successful VA ECMO on an adolescent pre-B cell acute lymphoblastic leukemia patient with necrotizing fasciitis from <i>Clostridium septicum</i>.","authors":"Jenna Miller, Johanna Orrick, Caroline Holton, David Juang","doi":"10.22551/2025.48.1203.10323","DOIUrl":"10.22551/2025.48.1203.10323","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) has historically been avoided in oncological patients due to perceived risks. However, recent literature suggests improved survival rates for pediatric oncology patients. Additionally, necrotizing fasciitis from <i>Clostridium septicum</i> is associated with high morbidity and mortality, especially in patients with preexisting malignancies. Few studies have explored the outcomes of ECMO in patients with both necrotizing fasciitis and hematologic malignancies. We present a case of a 16-year-old male with pre-B cell acute lymphoblastic leukemia (ALL) and <i>Clostridium septicum</i> necrotizing fasciitis successfully supported with veno-arterial (VA) ECMO. The patient underwent induction chemotherapy for ALL but developed severe septic shock and necrotizing fasciitis. The patient was deemed an ECMO candidate based on the favorable prognosis of both ALL and necrotizing fasciitis. He underwent ECPR and was cannulated onto VA ECMO. Surgical interventions were performed while on ECMO, including debridement and abdominal wound management. Despite complications such as gastrointestinal bleeding, the patient was successfully decannulated from ECMO after eight days. He recovered well, with no recurrence of bleeding, resumed chemotherapy, and was discharged home on day 54. Follow-up appointments showed remission from ALL and good functional recovery. This case highlights the feasibility and success of ECMO support in an adolescent with both ALL and necrotizing fasciitis. Careful patient selection, multidisciplinary collaboration, and aggressive management of complications are crucial for favorable outcomes in such complex cases. ECMO candidacy should be considered on an individual basis, even in patients with high-risk surgical interventions.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 3","pages":"119-122"},"PeriodicalIF":0.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980788","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":"Spontaneous upper extremity deep vein thrombosis as initial manifestation of a malignant mediastinal teratoma.","authors":"Christoph Sucker, Bartosz Zawislak","doi":"10.22551/2025.48.1203.10324","DOIUrl":"10.22551/2025.48.1203.10324","url":null,"abstract":"<p><p>Upper extremity deep vein thrombosis (UEDVT) is an uncommon clinical condition, accounting for fewer than 10% of all deep vein thromboses. While catheter-associated thrombosis and anatomical abnormalities are well-recognized causes, spontaneous UEDVT may occasionally serve as the first manifestation of an underlying malignancy. We report the case of a 43-year-old previously healthy male who developed spontaneous thrombosis of the left subclavian vein. He tested heterozygous for the Factor V Leiden mutation. Imaging revealed a large anterior mediastinal mass compressing the brachiocephalic vein. Histopathology confirmed a teratoma with enteric-type adenocarcinomatous differentiation. The patient underwent neoadjuvant chemotherapy followed by complete tumor resection and remained recurrence-free at one-year follow-up. This case underscores the importance of thorough diagnostic evaluation in patients with idiopathic UEDVT, particularly in the absence of catheterization or mechanical triggers. We review the spectrum of malignancy-associated UEDVT, including mechanisms such as venous compression, invasion, and paraneoplastic hypercoagulability. Spontaneous UEDVT can be the initial clinical sign of an occult malignancy. Early imaging and hemostatic assessment are crucial for timely diagnosis and treatment.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 3","pages":"123-126"},"PeriodicalIF":0.6,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980766","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":"Beyond BMI: revealing metabolic risk in lean MASLD.","authors":"Adrian Rotaru, Ermina Stratina, Laura Huiban, Irina Girleanu, Horia Minea, Catalin Sfarti, Stefan Chiriac, Anca Victorita Trifan","doi":"10.22551/2025.48.1203.10322","DOIUrl":"10.22551/2025.48.1203.10322","url":null,"abstract":"<p><p>While Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is normally associated with obesity, increasing evidence points to a substantial disease burden in individuals with normal body mass index (BMI), a phenotype referred to as \"lean MASLD.\" This study aims to characterize the prevalence, metabolic risk profile, and hepatic involvement in lean MASLD within an Eastern European population, and to assess the diagnostic limitations of BMI-centered screening. <b>Material and methods</b>: An observational study was conducted on 1,438 adults undergoing comprehensive metabolic and hepatic evaluation, including vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP) for liver steatosis and fibrosis. A detailed analysis focused on the normal-weight subgroup (BMI <25 kg/m²). In addition to standard anthropometric and laboratory markers, the CUN-BAE index was used to assess body fat composition. Performance of non-invasive indices (FLI, HSI, FIB-4, APRI, NFS) was evaluated, and multivariate logistic regression was used to identify predictors of steatosis and fibrosis. The study was conducted between January 2023 and February 2025. <b>Results:</b> MASLD was present in 19.28% of normal-weight individuals-an unexpectedly high prevalence given the absence of overt obesity. Despite normal BMI, this cohort demonstrated considerable metabolic dysfunction, including hypertension (26.47%), hypercholesterolemia (46.54%), and type 2 diabetes (18.38%). Visceral adiposity, as captured by the CUN-BAE score, emerged as a significant independent predictor of hepatic steatosis (p < 0.001). Conventional non-invasive steatosis and fibrosis scores exhibited only moderate discriminatory ability in lean individuals. Comparative analysis revealed significant metabolic and hepatic disparities between lean and obese MASLD phenotypes. <b>Conclusion:</b> Lean MASLD is an underrecognized yet clinically meaningful entity in Eastern Europe, frequently associated with metabolic derangements despite normal BMI. Reliance on BMI alone may obscure diagnosis and delay intervention. Visceral adiposity assessment and advanced non-invasive hepatic evaluation should be integrated into screening strategies to improve early detection and risk stratification in lean individuals.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 3","pages":"110-118"},"PeriodicalIF":0.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786031","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":"MASLD risk prediction in IBD: development of two tailored clinical scores.","authors":"Remus Stafie, Robert Nastasa, Carol Stanciu, Cristina Muzica, Sebastian Zenovia, Ana Maria Singeap, Mihaela Dimache, Anca Victorita Trifan","doi":"10.22551/2025.48.1203.10321","DOIUrl":"10.22551/2025.48.1203.10321","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in patients with inflammatory bowel disease (IBD), but accurate, disease-specific predictive tools are lacking. This study aimed to identify key risk factors and develop tailored prediction models for MASLD in IBD patients. <b>Material and methods</b>: In a retrospective-prospective cohort of 157 IBD patients (Ulcerative colitis: 51.6%; Crohn's disease: 48.4%), we performed serial clinical, laboratory, and imaging evaluations across four clinical visits. Hepatic steatosis was assessed using transient elastography with controlled attenuation parameter (CAP >273 dB/m). Logistic regression identified independent risk factors for MASLD, leading to the development of an additive clinical score and a logistic regression-based score. Their diagnostic performances were compared with established indices (Hepatic steatosis index (HSI), Fatty liver index (FLI)). <b>Results</b>: MASLD was diagnosed in 37 patients (23.5%). Independent predictors included smoking (OR 3.55), dyslipidemia (OR 2.82), hypertension (OR 2.77), prolonged IBD duration, higher BMI, male sex, frequent disease flares, and corticosteroid exposure. The additive score (cut-off ≥3) showed good sensitivity (36.1%) but high specificity (94%). The logistic score (cut-off ≥3.5) achieved moderate specificity (45.3%) with excellent sensitivity (86.1%). Both models outperformed HSI (AUC 0.671) and FLI (AUC 0.701). CAP remained the most accurate tool (AUC 0.957). <b>Conclusion</b>: MASLD is highly prevalent in IBD patients, driven by both metabolic and disease-specific factors. The proposed clinical scores provide simple, accessible tools for early risk stratification, potentially guiding personalized surveillance in settings lacking advanced imaging technologies.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 3","pages":"102-109"},"PeriodicalIF":0.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786054","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":"Obesity alters metabolic profiles in children with acute pancreatitis, but not disease severity and recurrence: a Romanian cohort study.","authors":"Corina Valentina Dragu, Alexandra Coroleuca, Anca-Ioana Badarau, Cristina Adriana Becheanu","doi":"10.22551/2025.47.1202.10319","DOIUrl":"10.22551/2025.47.1202.10319","url":null,"abstract":"<p><p>Childhood obesity has been increasingly recognized as a risk factor for acute pancreatitis (AP). This study investigates the impact of obesity and a novel composite metabolic risk variable (MAC - Metabolic at Risk in Context) on the biochemical, inflammatory, and clinical profiles of Romanian children with AP.</p><p><strong>Material and methods: </strong>A retrospective cohort study included 90 pediatric patients hospitalized for a first episode of AP at Grigore Alexandrescu Children's Emergency Clinical Hospital in Bucharest over a three-year period. Patients were classified as obese or non-obese based on BMI percentiles. The MAC variable was defined as positive if the patient had at least one of the following: total cholesterol >170 mg/dL, GGT >40 U/L, or total lipids >500 mg/dL. Associations between obesity, MAC, inflammatory markers, disease severity, and recurrence were analyzed using regression models.</p><p><strong>Results: </strong>Nineteen patients (21.1%) were obese, and 35 (38.9%) were MAC-positive. Obese patients were older (median age 15 vs. 9.5 years) and had significantly higher total cholesterol, GGT, and total lipid levels. MAC positivity was more frequent in obese patients (68.4% vs. 26.8%, p < 0.001). Biliary pancreatitis was significantly more common among obese patients (p = 0.0043), while no association was found between MAC and biliary etiology. Neither obesity nor MAC predicted severity or recurrence. In contrast, lower lymphocyte counts were inversely associated with severity (p<0.01), suggesting that lymphopenia may serve as a biomarker of severe disease.</p><p><strong>Conclusions: </strong>Obesity and metabolic abnormalities are frequent in pediatric AP and are associated with biliary etiology, but not with increased severity or recurrence. The use of the MAC variable provides a novel approach to identify children at metabolic risk beyond BMI status. Additionally, lymphocyte counts may serve as a practical biomarker for identifying children at risk for severe AP. These findings highlight the need for integrated metabolic and immune assessments in pediatric AP management.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 2","pages":"90-97"},"PeriodicalIF":0.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644209","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":"The evolution of prenatal Whole Exome Sequencing: from cytogenetics to precision medicine.","authors":"Ileana Delia Săbău, Laurenţiu-Camil Bohîlţea, Valentin Varlas, Adelina Silvana Gheorghe, Maria Riza, Nicolae Suciu, Iuliana Ceauşu","doi":"10.22551/2025.47.1202.10318","DOIUrl":"10.22551/2025.47.1202.10318","url":null,"abstract":"<p><p>Prenatal genetic diagnostics have undergone a remarkable transformation, progressing from early cytogenetic techniques such as karyotyping and fluorescence in situ hybridization (FISH) to chromosomal microarray analysis (CMA) and, most recently, whole exome sequencing (WES). WES has emerged as a groundbreaking tool, allowing for identifying single-gene mutations, small insertions and deletions, and other pathogenic variants responsible for rare and complex diseases. Unlike conventional approaches, which primarily detect large chromosomal abnormalities, WES provides a high-resolution analysis of the fetal genome, significantly improving diagnostic accuracy and enabling early intervention. This review explores the historical evolution of prenatal genetic testing, highlighting key milestones from the introduction of cytogenetics in the 1960s to the integration of WES in clinical practice over the last decade. WES has proven instrumental in diagnosing monogenic disorders, uncovering the genetic basis of fetal anomalies, and investigating cases of stillbirth and recurrent pregnancy loss (RPL). However, despite its immense clinical utility, challenges such as the interpretation of variants of uncertain significance (VUS), ethical concerns surrounding incidental findings, and the financial burden associated with sequencing continue to impact its widespread adoption. Future directions in WES include its potential integration with non-invasive prenatal testing (NIPT), advancements in artificial intelligence (AI)-driven bioinformatics, and its role in precision medicine, offering more personalized and data-driven approaches to prenatal care. As technological innovations continue to enhance the speed, accuracy, and affordability of WES, its role as a cornerstone of modern prenatal diagnostics is expected to expand, shaping the future of fetal genetic screening and clinical decision-making.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 2","pages":"80-89"},"PeriodicalIF":0.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644211","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":"Teclistamab-associated cytokine release syndrome in multiple myeloma: a case-based literature review of mechanisms, management, and clinical implications.","authors":"Muhammad Cheema, Salman Syed, Zoha Ghuman, Asma Iftikhar","doi":"10.22551/2025.47.1202.10320","DOIUrl":"10.22551/2025.47.1202.10320","url":null,"abstract":"<p><p>Cytokine release syndrome (CRS) is a potentially life-threatening inflammatory condition that can occur after immune-based therapies, such as bispecific antibodies. We present the case of a 66-year-old woman with relapsed/refractory multiple myeloma who developed fatal CRS following treatment with Teclistamab, a bispecific antibody that targets CD3 on T cells and B-cell maturation antigen on myeloma cells. The patient had previously achieved remission with rituximab, bortezomib, and autologous stem cell transplantation but experienced a relapse after eight years. Teclistamab was initiated with a step-up dosing regimen. Before treatment, she received premedication with intravenous fluids, steroids, and tocilizumab. Despite this premedication, the patient was readmitted with fever, chills, and shortness of breath, leukopenia, and hypoxia. Imaging studies indicated pneumonia. During her hospitalization, her condition deteriorated rapidly, resulting in respiratory failure and refractory shock. She was transferred to the intensive care unit (ICU), where she required mechanical ventilation and multiple pressor support. Despite aggressive resuscitation efforts, she progressed to multi-organ failure, and the family ultimately chose to withdraw care. CRS is characterized by a systemic inflammatory response with rapid and excessive release of cytokines, particularly IL-6, IL-2, IL-10, IFN-γ, and GM-CSF. Severe CRS can clinically resemble sepsis. Management strategies include early recognition, supportive care, and immunomodulatory therapy, particularly with tocilizumab and corticosteroids. This case underscores the diagnostic and therapeutic challenges of differentiating severe CRS from infection. This case uniquely contributes to current understanding by highlighting the limitations of current premedication protocols and emphasizing the critical need for enhanced monitoring and rapid intervention protocols in managing Teclistamab-induced CRS. It highlights the critical need for prompt, targeted intervention to prevent fatal outcomes in patients receiving novel immunotherapies.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 2","pages":"98-101"},"PeriodicalIF":0.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644210","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":"Dextrocardia as an uncommon cause of inferior ST-segment elevation.","authors":"Ravi Vazirani Ballesteros, Eliomar García-Bello, Pablo Zulet","doi":"10.22551/2025.47.1202.10314","DOIUrl":"10.22551/2025.47.1202.10314","url":null,"abstract":"<p><p>A 36-year-old woman with surgically repaired transposition of the great vessels was admitted with psychiatric symptoms. The 12-lead ECG showed ST-segment elevation in the inferior leads, a positive P wave in aVR, and an absent R wave progression in the precordial leads. The findings were attributed to atrial repolarization (Ta) waves in the setting of dextrocardia and low atrial rhythm, causing ST-segment elevation in the inferior leads. No cardiac symptoms were present, and additional tests ruled out ischemia. Atrial repolarization waves are typically imperceptible on ECG but can become evident in certain conditions, such as low atrial rhythm. This case represents a rare coexistence of dextrocardia and ST-segment elevation due to an inverted atrial repolarization wavefront in the setting of low atrial rhythm. Recognizing this pattern is essential to prevent misdiagnosis and avoid unnecessary procedures.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 2","pages":"59-61"},"PeriodicalIF":0.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144582","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 carbamazepine-induced cardiotoxicity with multisystem involvement: early recognition and advanced therapeutic approach.","authors":"Raluca Ecaterina Haliga, Adorata Elena Coman, Roxana Ioana Mihai, Bianca Codrina Morarasu, Alexandr Ceasovschih, Victorita Sorodoc","doi":"10.22551/2025.47.1202.10315","DOIUrl":"10.22551/2025.47.1202.10315","url":null,"abstract":"<p><p>Carbamazepine (CBZ) toxicity is a medical emergency due to severe neurological and cardiovascular risks. Management is challenging due to CBZ's prolonged elimination, enterohepatic recirculation, and active metabolites. We report a severe CBZ intoxication in a 23-year-old male who ingested 24 g in a suicide attempt. He presented in profound coma (Glasgow Coma Scale 3) with respiratory failure, requiring orotracheal intubation and mechanical ventilation. ECG showed sinus tachycardia and slightly widened QRS complexes. Echocardiography revealed myocardial depression with a left ventricular ejection fraction of 40%. His CBZ plasma level was critically high (44 mcg/mL). Treatment included multiple-dose activated charcoal, intravenous lipid emulsion, and continuous venovenous hemodiafiltration, leading to rapid CBZ clearance, cardiotoxicity reversal, and neurological recovery. He was extubated on day three and discharged in stable condition. This case highlights severe CBZ-induced cardiotoxicity and emphasizes early recognition and advanced therapies for improved outcomes.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 2","pages":"62-65"},"PeriodicalIF":0.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144597","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}