European Journal of Case Reports in Internal Medicine 2021-10-19T22:59:42+00:00 Editorial Office Open Journal Systems <p><strong>The&nbsp;<span class="HPblu">European Journal of Case Reports in Internal Medicine</span>&nbsp;</strong>is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from&nbsp;<a href="">33 European countries</a>.&nbsp;<br><br>The journal’s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field.&nbsp;<strong><br><span class="HPblu">EJCRIM&nbsp;</span></strong>welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight, contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors).&nbsp;<strong><br></strong>The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.<br><br> <strong>EJCRIM</strong> is peer-reviewed with single-blind review and freely accessible to all.</p> Light Chain (AL) Cardiac Amyloidosis: A Diagnostic Dilemma: A Case Report 2021-10-19T22:59:42+00:00 Basel Abdelazeem Nouraldeen Manasrah Rudin Gjeka Arvind Kunadi <p>Amyloidosis is a clinical condition characterized by amyloid fibril deposition into different organ systems. The most common types are light chain (AL) amyloidosis and transthyretin amyloidosis (ATTR) amyloidosis. Amyloidosis involves the heart with an incidence of 1.38 to 3.69 per 100,000 person-years and a prevalence of 14.85 per 100,000 person-years between 2004 and 2018. Diagnosis of cardiac amyloidosis can be made through cardiac imaging, including cardiac magnetic resonance imaging and 99mTc-labeled pyrophosphate cardiac scan. However, a tissue biopsy is frequently needed to confirm the diagnosis. Herein, we report such a case of cardiac amyloidosis. The patient presented with pericardial effusion and acute kidney injury as the initial presentation. The presumptive diagnosis was ATTR amyloidosis, but the endomyocardial biopsy confirmed the diagnosis of AL amyloidosis. The patient was started on bortezomib, cyclophosphamide, and dexamethasone therapy. We aimed to highlight the different diagnostic modalities of cardiac amyloidosis and the importance of obtaining tissue biopsy to confirm the amyloidosis type before starting the treatment.&nbsp;</p> Copyright (c) Acute suppurative thyroiditis secondary to Eschericia coli 2021-10-19T17:19:35+00:00 Nida Siddiqui Nikola Deletic Frederick Raal Farzahna Mohamed <p>Infections of the thyroid gland are rare. It’s innate resistance to infections can be attributed to its unique anatomical features and rich blood supply. High clinical suspicion is required as a delay in diagnosis can lead to significant morbidity and mortality. Major pathogens include the gram-positive staphylococcus aureus and streptococcus species however, gram-negative organisms have been found especially in immunocompromised hosts. We present a rare case of acute suppurative thyroiditis (AST) secondary to Escherichia Coli (E. coli) in a woman known to be infected with human immunodeficiency virus (HIV).</p> Copyright (c) Allergic Bronchopulmonary Aspergillosis Masquerading as Chronic Obstructive Pulmonary Disease Exacerbation 2021-10-19T01:40:36+00:00 Ibukun Fakunle <p><span style="font-weight: 400;">Allergic bronchopulmonary aspergillosis (ABPA) is a well-described hyperinflammatory condition that has sequelae of bronchiectasis. It is more predominantly found in patients with asthma or cystic fibrosis with atopy. There is literature to suggest that patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing allergic bronchopulmonary aspergillosis. It is not clear how often patients with COPD with concurrent ABPA are not identified in the clinical setting. We describe a 58 year old woman, known to have COPD and childhood-onset moderate persistent asthma who presented with shortness of breath, increased sputum production, and malaise. She was initially suspected of having an exacerbation of COPD, however, a more thorough history taking and review of her chest computerized tomography (CT) led to a diagnosis of acute exacerbation of bronchiectasis secondary to ABPA.</span></p> Copyright (c) MYCOBACTERIUM CHELONAE CUTANEOUS INFECTION: A CHALLENGE FOR AN INTERNIST 2021-10-18T21:24:59+00:00 Margarida Gaudencio André Carvalho Maria Inês Bertão Ivo Barreiro Maria Isabel Bessa Abílio Gonçalves <p>Cutaneous infections by the <em>Mycobacterium chelonae </em>complex show a heterogeneous clinical presentation, which varies according to the patient’s immune status. Most standard antimycobacterials show no effect against these species. Clarithomycin alone was shown to be an adequate treatment, however, resistance has been reported. Therefore, current literature supports multi-drug therapy to avoid resistant strains. Here, we present a case report of a 59-year-old male, who was under systemic immunosuppresive therapy and develop cutaneous lesions which evolution was highly suggestive of atypical infection.<span class="Apple-converted-space">&nbsp;</span></p> Copyright (c) Paraganglioma - an unexpected diagnosis in a patient with cerebral venous sinus thrombosis and SARS-CoV-2 infection 2021-10-18T18:37:38+00:00 Olinda Lima Miranda André Pereira Margarida Castro Nuno Carvalho David Paiva Clarisse Neves Jorge Cotter <p>27-year-old male, with recent SARS-CoV-2 infection, went to the emergency department for severe left occipital headache, associated with nausea and an episode of vomiting. On physical examination without neurological deficits. The cerebral computed tomography (CT) scan documented a "spontaneous hyperdensity of the rectus and transverse sinuses on the left, as well as of the posterior aspect of the superior longitudinal sinus by venous sinus occlusion”. He started hypocoagulation and was admitted for surveillance and etiological study. In the study performed, the abdominoplevic CT showed an uptake mass in the retroperitoneum to the left, laterally to the aorta, with 52 x 35. A PET-FDG showed a mass with associated glycolytic hypermetabolism, suggestive of malignant etiology. Plasma and urinary metanephrines were performed with a positive result.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Cerebral venous thrombosis (CVT) is the complete or partial occlusion of the main venous sinuses or cortical veins. The most known risk factors are oral contraceptives, pregnancy, prothrombotic conditions, malignancy and infections.Headache is the most common symptom in cerebral venous thrombosis. The treatment consists in anticoagulants. The SARS-CoV-2 infection has been associated with a hypercoagulable state, which is not fully understood. There are some reported cases of CVT in SARS-CoV-2 patients. Although infection is one of the possible causes of CVT, it is important to rule out genetic causes (thrombophilia) and malignancy.</p> Copyright (c) Ceftriaxone induced encephalopathy: a pharmacokinetic approach 2021-10-18T14:12:36+00:00 Laurent Jadot Aurelie Judong Jean-Luc Canivet Noel Lorenzo Villalba Pierre Damas <p>&nbsp;</p> <p style="margin: 0cm 0cm 0pt; text-align: justify; line-height: 200%; -ms-text-justify: inter-ideograph;"><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 10pt;">We report a case of ceftriaxone-induced encephalopathy correlated with high cerebrospinal fluid concentration. Neurotoxicity of cephalosporin is increasingly reported, especially regarding fourth-generation cephalosporins. The factors influencing the corticospinal fluid (CSF) concentration are plasma concentration, liposolubility, ionization, molecular weight, protein binding and efflux. In our patient, high levels of ceftriaxone (27.9 mg/l) were found in the CSF. &beta;-lactam associated neurotoxicity is mainly related to similarities between GABA and &beta;-lactam ring. Because of disparate CSF/plasma ratio and blood-brain barrier efflux among patients, plasmatic drug&nbsp;monitoring probably cannot be used as a surrogate of CSF concentration. This is, as we know, the first case of described ceftriaxone-induced encephalopathy associated with an objective excessive cerebrospinal concentration.</span></p> <p>&nbsp;</p> <p style="margin: 0cm 0cm 0pt; text-align: justify; line-height: 200%; -ms-text-justify: inter-ideograph;"><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 10pt;">&nbsp;</span></p> <p>&nbsp;</p> Copyright (c) Generalized Myasthenia Gravis presented with New Onset Dysphagia 2021-10-18T05:08:47+00:00 Maya Yakir Gad Segal Dor Cohen Eduard Itelman Shahar Shelly <p>Myasthenia Gravis (MG) is an autoimmune neuromuscular junction disorder characterized by fluctuating weakness and fatigability of skeletal muscles. More rarely it can present with isolated symptom. Here, we present the case of a 66-year-old male, who presented with two months of difficulty swallowing and severe weight loss. He was diagnosed with dysphagia with negative workup for possible etiology. Nerve conduction studies showed decrement in slow repetitive nerve stimulation (RNS) and Myasthenia Gravis was diagnosed.</p> Copyright (c) Case Report: A Rare Cause of Pedunculated polyps caused by Strongyloides. 2021-10-17T18:07:22+00:00 Omer Yousaf, MD Arisha Carreon, DO Ibrahim Mohsin, MD <p><strong>&nbsp;</strong></p> <p><strong>Introduction </strong></p> <p>Strongyloidiasis is a systemic disease caused by the nematode, Strongyloides stercoralis. Strongyloides is unique among other parasites as it can remain undetected for decades. Although patients may present with typical symptoms of a skin rash, cough, or diarrhea, a rare manifestation of infection is pseudopolyposis in the colon. This case highlights the unique finding of pseudopolyposis in a patient with strongyloidiasis with negative stool studies.&nbsp;</p> <p><strong>&nbsp;</strong></p> <p><strong>Patients and Methods </strong></p> <p>We present a case of an 81 year old male with a delayed diagnosis of strongyloidiasis. The patient initially presented to the clinic for evaluation of productive cough, and was treated empirically for bronchitis. He subsequently developed vomiting and diarrhea with imaging revealing circumferential wall thickening of the ascending colon, consistent with colitis. Although stool tests negative, the patient was treated with antibiotics, and then underwent a colonoscopy which revealed multiple polyps. Biopsy results confirmed&nbsp;<em>Strongyloides</em>&nbsp;infection. The patient was treated with ivermectin and improved.</p> <p>&nbsp;</p> <p><strong>&nbsp;</strong></p> <p><strong>Discussion </strong></p> <p>This case illustrates the unique finding of colonic pseudopolyposis in a patient infected with strongyloides in rural southwest Virginia. Strongyloidiasis is often misdiagnosed due to its nonspecific gastrointestinal symptoms and the chronic nature of the disease . Although stool studies were routinely negative for parasitic infection, CT scan findings suggestive of colitis should be followed by colonoscopy with biopsy of any abnormal lesion in the right clinical context. Determining the definitive diagnosis in a timely manner is crucial for determining the specific treatment and resolution of the disease.</p> Copyright (c) KOUNIS SYNDROME: DEXKETOPROFEN-ASSOCIATED ST-ELEVATION MYOCARDIAL INFARCTION 2021-10-16T07:09:49+00:00 Aytekin Aksakal Zeki Simşek Diyar Köprülü Uğur Arslan <p>Allergic angina and allergic myocardial infarction are common diseases associated with acute coronary syndromes and encompass a wide spectrum of mast cell activation disorders termed "Kounis Syndrome". We present here a Kounis syndrome presenting with sudden cardiac arrest after intravenous infusion of dexketoprofen to the emergency room.</p> Copyright (c) PSITTACOSIS – ANAMNESIS AS A DIAGNOSTIC TOOL 2021-10-15T16:09:34+00:00 Beatriz Fernandes João Casanova Pinto Ana Catarina Lopes Carlos Pinhão Ramalheira <p>Psittacosis is an infrequent cause of community-acquired pneumonia. We present a case of a 37-year-old man with fever, myalgia, diarrhoea, and cough. On physical examination, inspiratory crackles in the right hemithorax were noted. He had elevated inflammatory markers. The patient was discharged with the diagnosis of non-severe community-acquired pneumonia. At the follow-up appointment, anamnesis was positive for high-risk bird exposure. The serologic study supported the diagnosis of psittacosis.</p> Copyright (c)