European Journal of Case Reports in Internal Medicine 2020-04-03T12:13:03+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> Anosmia and Dysgeusia in the Absence of Other Respiratory Diseases: Should COVID-19 Infection Be Considered? 2020-04-03T12:13:03+00:00 Noel Lorenzo Villalba Yasmine Maouche Maria Belen Alonso Ortiz Zaida Cordoba Sosa Jean Baptiste Chahbazian Aneska Syrovatkova Pierre Pertoldi Emmanuel Andres Abrar-Ahmad Zulfiqar <p>We describe two elderly patients evaluated at emergency departments for anosmia/dysgeusia in the absence of any other respiratory symptoms prior to or upon admission. In the current epidemiological context, clinical and biological work-up led to a diagnosis of COVID-19 infection. Unfortunately, one of the patients died during hospitalization, but the other recovered and was discharged.</p> 2020-04-03T12:13:01+00:00 ##submission.copyrightStatement## The Emphysematous Pancreatitis: A Rare Complication of Acute Necrotizing Pancreatitis 2020-04-03T07:06:00+00:00 Niryinganji Révérien Mountassir Shuruk Siwane Abdellatif Tabakh Houria Touil Najwa Kacimi Omar Chikhaoui Nabil <p>Emphysematous pancreatitis is a rare and fatal complication of acute necrotizing pancreatitis. We report a radioclinical observation of a 61-year-old female patient who consulted for epigastric pain radiating to the back, associated with vomiting and elevated lipasaemia more than 3 times the normal value. The abdominal computerized tomography (CT) scan carried out on the fourth day of hospitalization, based on worsening of the clinical condition, showed pancreatic necrosis associated with the presence of air bubbles. Percutaneous puncture of a peripancreatic collection was positive for <em>Escherichia coli</em>. A diagnosis of emphysematous pancreatitis was established. The clinical and biological evolution of our patient was favourable with antibiotic treatment.</p> 2020-04-03T07:05:58+00:00 ##submission.copyrightStatement## Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine 2020-04-02T08:14:16+00:00 Sumeet Yadav Michelle Talukder Jacky Duong <p>Hemiplegic migraine (HM) is a rare type of migraine which presents with motor and sensory impairment like a cerebrovascular accident (CVA). We present a case of a 36-year-old female, with a prior CVA treated with alteplase, who presented to the emergency department with stroke-like symptoms with a duration of 1 hour. The NIH Stroke Scale score was 22 at presentation. The patient received alteplase under the supervision of a neurologist after head CT confirmed no bleed. Further work-up revealed no acute or remote ischaemia or infarction. This case demonstrates the importance of a thorough history, intercommunication between health systems and integrated Electronic Medical Records (EMR) for early diagnosis and management of HM.</p> 2020-04-02T08:05:00+00:00 ##submission.copyrightStatement## Amoxicillin-induced Aseptic Meningitis 2020-04-02T08:14:16+00:00 Débora Sousa Pedro Raimundo <p>Amoxicillin is a semi synthetic beta-lactam antibiotic that belongs to the penicillin family. It is the most prescribed antibiotic in the world. It has few side effects, even though hypersensitivity reactions may occur, with potential life-threatening effects. The authors present the case of a 63 years-old male admitted in the emergency department with a two-week history of fever and occipital headache. The symptoms began after he started antibiotic prophylaxis with amoxicillin for a dental procedure. Cerebrospinal fluid analysis was suggestive of aseptic meningitis and the patient improved quickly after discontinuation of the drug. The patient’s previous medical history highlighted a similar episode after he had started taking amoxicillin as part of a scheme for the treatment of a <em>Helicobacter pylori</em> infection. Aseptic meningitis is an extremely rare adverse reaction of amoxicillin, with only 16 cases reported in literature.</p> 2020-04-01T08:31:05+00:00 ##submission.copyrightStatement## Syncope Caused by a Head and Neck Cancer Controlled by a Permanent Pacemaker 2020-04-02T08:14:16+00:00 Ana Rita Barradas Francisco Albuquerque Mariana Constante Margarida Fonseca Filipe Correia João Lopes Delgado <p>Syncope caused by carotid sinus syndrome due to head and neck cancer is rare. We report a case of recurrent syncope as a result of extreme bradycardia requiring pacemaker implantation. The patient began chemotherapy and radiation therapy to treat the underlying cause. When diagnosed early, a positive outcome is expected in these situations.</p> 2020-03-31T07:58:09+00:00 ##submission.copyrightStatement## Idiopathic CD4+ T-cell Lymphocytopenia: Report of a Case 11 Years after Diagnosis 2020-03-30T10:34:55+00:00 Noel Lorenzo Villalba Abrar-Ahmad Zulfiqar Yasmine Maouche Zaida Cordoba Sosa Maria Belen Alonso Ortiz Emmanuel Andres <p>We report the case of a 23-year-old woman evaluated for asthenia and lymphocytopenia. Clinical examination was unremarkable but laboratory tests showed the presence of CD4 lymphocytopenia. Secondary causes of CD4 lymphocytopenia were ruled out and a previous diagnosis of idiopathic CD4+ T-cell lymphocytopenia was retained. CD4 lymphocytopenia has persisted for 11 years now but the patient has been clinically asymptomatic.</p> 2020-03-30T07:34:23+00:00 ##submission.copyrightStatement## Cannabis Hyperemesis Syndrome: A Still Under-Recognized Syndrome 2020-03-30T10:34:55+00:00 Attout Hassene Amichi Sofia Josse Françoise Appavoupoule Vincent Randriajohany Andrey Thirapathi Yogananda <p>Cannabis is one of the most widely used illicit drugs in the world. Its use is associated with several short- and long-term side-effects such as changes in mood, impaired memory, impaired attention, depression and anxiety, and it is correlated with schizophrenia. Cannabinoid hyperemesis syndrome (CHS) is characterized by chronic cannabis use, cyclic intractable nausea and vomiting, and compulsive hot bathing. Patients are typically diagnosed with CHS only after multiple medical evaluations. Recent research has identified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This effect may explain hyperemesis in cannabis users. The thermoregulatory role of endocannabinoids may be responsible for compulsive hot bathing. We describe the cases of two young men seeking repeated emergency room care with recurrent nausea and vomiting. Abstinence from cannabis led to resolution of vomiting symptoms and abdominal pain.</p> 2020-03-27T09:21:53+00:00 ##submission.copyrightStatement## Abdominal Pain: A Real Challenge in Novel COVID-19 Infection 2020-03-28T09:30:33+00:00 Erika Poggiali Pau Mateo Ramos Davide Bastoni Andrea Vercelli Andrea Magnacavallo <p>COVID-19 (coronavirus disease 19) is an infectious disease caused by coronavirus SARS-CoV-2. Since its detection in China at the end of 2019, the novel coronavirus has rapidly spread throughout the world and has caused an international public health emergency. The most common manifestation is flu-like symptoms. Mild infections usually improve within a few days, but COVID-19 can cause severe pneumonia with acute respiratory distress syndrome and death. Gastrointestinal symptoms are less common but possible and more difficult to recognize as part of a COVID-19 syndrome. In line with the current opinion of the WHO, we strongly believe that preventive measures and early diagnosis of COVID-19 are crucial to interrupt virus spread and avoid local outbreaks. We report the cases of COVID-19 patients admitted to our Emergency Department who complained of gastrointestinal symptoms at admission.</p> 2020-03-26T11:31:44+00:00 ##submission.copyrightStatement## Food for Thought: Dietary Intervention in a Rare Cause of Severe Ventilatory Failure 2020-03-26T11:57:00+00:00 Henry Yung Keshav Sharma William Flowers Malcolm Marquette Laura Starace Clare Sander Rowan Burnstein Jurgen Herre <p>Plastic bronchitis is a rare condition characterised by endobronchial cast formation. We report the case of a 53-year-old women who deteriorated following an elective bronchoscopy procedure. She developed refractory ventilatory failure and required repeated bronchoscopy, which identified thick tenacious casts as the cause of her airway compromise. She did not respond to conventional therapies including endoscopic clearance, mucolytic therapy and nebulised tissue plasminogen activator (TPA). Total parenteral nutrition and a fat-free enteral diet were instituted while the patient was on extracorporeal membrane oxygenation (ECMO), which led to substantial improvement in her condition and demonstrated the importance of dietary strategies in this case.</p> 2020-03-26T08:07:30+00:00 ##submission.copyrightStatement## Fulminant Emphysematous Hepatitis – A Rare Cause of Septic Shock 2020-03-26T11:57:00+00:00 Gonçalo Miranda Ana Catarina Dionísio Constança Azevedo Eduardo Carvalho Miguel Semião Vítor Branco Miguel Castelo-Branco <p>Emphysematous hepatitis is a rare entity characterized by the replacement of hepatic parenchyma by gas, leading to acute liver failure. Often it occurs in patients with diabetes mellitus, liver disease or a recent history of abdominal surgery. We present a case of emphysematous hepatitis in a 74-year-old man with no recognizable risk factors. Despite the early broad-spectrum antimicrobial therapy and supportive care, the condition progressed to a fatal outcome, as seen in other case reports. Early recognition of this condition and rapid and aggressive management may improve patient outcomes.</p> 2020-03-25T10:01:12+00:00 ##submission.copyrightStatement##