European Journal of Case Reports in Internal Medicine 2021-07-31T22:20:38+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> Fulminant hemolysis following endoscopic retrograde cholangiopancreatography 2021-07-31T22:20:38+00:00 Mário Bibi Susana Viana Cátia Leitão Rui Moço Yuliana O. Eremina <p>We report a case of a 77-year-old-man with a history of type 2 diabetes mellitus who underwent an endoscopic retrograde cholangiopancreatography (ERCP) due to a gallstone in the common bile duct. Thirty-six hours after the procedure the patient developed persistent fever and epigastric pain associated with <em>de novo</em> jaundice. Massive hemolysis (with exuberant spherocytosis) occurred and patient died in 3 hours. A <em>Clostridium perfrigens</em> was isolated in the blood cultures. Massive hemolysis associated to <em>Clostridium perfrigens</em> has a high mortality rate. Management involves a high index of its suspicion after gastrointestinal procedures like ERCP, surgical consultation, antibiotic therapy, transfusion of red cell concentrates and, potentially, hyperbaric oxygen therapy.</p> Copyright (c) Recurrent hemoptysis revealing a Hughes-Stovin syndrome 2021-07-31T16:58:19+00:00 Nedia Moussa Tasnim Znegui Mouna Snoussi Rahma Gargouri Zouhaier Bahloul Sourour Abid samy kammoun <p>Hughes-Stovin syndrome is a very rare pathology with no defined diagnostic criteria. We present a case of a 26-year old man who had hemoptysis revealing a Hughes-Stovin syndrome, through this case we will consider the etiopathogenic, therapeutic and evolutionary aspects of the disease.</p> Copyright (c) Tumor Lysis Syndrome in Prostate Cancer – a rare complication 2021-07-30T12:00:23+00:00 João Eduardo Pina Cabral Joana Coelho Jorge Fortuna Adriano Rodrigues <p>Tumor lysis syndrome is a well-documented oncologic emergency, most commonly found in hematologic and high turn-over solid neoplasia. It’s incidence in solid, low turnover neoplasia is harder to ascertain because it is based primarily in isolated case reports. It may have a trigger, such as chemotherapy or infection, or it may be spontaneous. A brief review of available literature was performed along with a case presentation of a 58-year-old male patient with prostate cancer who developed tumor lysis syndrome.</p> Copyright (c) MIXED CRYOGLOBULINEMIA VASCULITIS AFTER PERSISTENT HEPATITIS C VIRUS ERADICATION 2021-07-29T15:13:17+00:00 Margarida Gaudencio Rui Nogueira Nuno Afonso Oliveira <p class="p1"><span class="s1">Mixed cryoglobulinemia vasculitis (MCV) is a systemic vasculitis of the small and medium-size vessels caused by active hepatitis C (HCV) infection in &gt; 80% of cases. Beuthien et al presented the first case of MCV with undetectable HCV, after 10 months of therapy. In the last few years, more authors described another cases of sintomatic MCV after 1 year of persistent HCV eradication. Here, we present a case report of a 57-year-old male, who developed a MCV with renal involvement after 3 years of HCV eradication with interferon therapy.<span class="Apple-converted-space">&nbsp;</span></span></p> Copyright (c) Reccurrence of Graves’ disease (a Th1-type cytokine disease) following SARS-CoV-2 mRNA vaccine : a simple coincidence ? 2021-07-29T12:14:23+00:00 Guillaume Pierman Etienne Delgrange Corinne Jonas <p>Graves’ disease is the most frequent cause of hyperthyroidism in young women. This auto-immune disease is due to the production of class 1 IgG stimulating the TSH receptor. These antibodies are produced secondary to a Th1 immune response in which interferon ? plays a key role. Vaccination is ongoing worldwide against SARS-CoV-2 and some of the vaccines used are from mRNA which seems to stimulate the TH-1 immune response. Here, we report a case of recurrence of hyperthyroidism due to Graves’ disease following mRNA vaccination and discuss the possible implicated mechanism. This observation argues for a systematic study of a population of patients with previous Graves’ disease in order to assess the risk of recurrence following vaccination.</p> Copyright (c) Pulmonary nodules in elderly patient with pancreatic cancer 2021-07-29T01:20:16+00:00 Marcus Villander Sá Bianca Castelo Branco Rocha Flávio Pacheco Jorge Carvalho Gustavo Miranda Luydson Vasconcelos <p>Pulmonary histoplasmosis is a fungal infection that can show itself in many different forms, especially in immunocompromised individuals. Its nodular form has a special importance due its differential diagnosis with pulmonary metastasis. We present a case of a 84-year-old male with a pancreatic adenocarcinoma and multiple pulmonary nodules, being diagnosed with pulmonary histoplasmosis</p> Copyright (c) Guillain-Barré syndrome as rare initial manifestation of esophageal carcinoma 2021-07-28T11:29:13+00:00 Maria Duarte Raquel Rocha Filipe Correia <p>Polyneuropathies may be part of a paraneoplastic syndrome as the first symptom of a carcinoma. The investigation of an occult neoplasm should be part of the etiological investigation of neurological syndromes of undetermined etiology. The relationship between Guillain-Barré syndrome (GBS) and malignancy is still controversial and, to our knowledge, there are only two previous reports of GBS associated with esophageal carcinoma. We describe the third case of a possible relationship between GBS and esophageal carcinoma.</p> <p>Keywords: Esophageal carcinoma, Guillain-Barré syndrome, Paraneoplastic neurological syndromes.</p> Copyright (c) Pulmonary involvement responsive to enzyme replacement therapy in an elderly patient with Gaucher disease 2021-07-27T13:43:19+00:00 Pascal Cathébras Baptiste Gramont Dylan Vellas Rémi Grange <p>Type 1 Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder caused by a deficient activity of beta-glucocerebrosidase, leading to an accumulation of its substrate (glucosylceramide) into macrophages of the reticuloendothelial system, then referred to as Gaucher cells. The most frequent symptoms are asthenia, spleen and liver enlargement, bone abnormalities and cytopenia due to bone marrow infiltration. Lung involvement in GD is a rare finding, and it is unclear whether it may regress under enzyme replacement therapy (ERT) or substrate reduction therapy (SRT). Here we report the case of a type 1 GD lately diagnosed in an elderly patient complicated by infiltrative lung disease, which responded to ERT.</p> Copyright (c) Non specific interstitial pneumonia revealing an antisynthetase syndrome 2021-07-26T17:21:57+00:00 Nadia Moussa Rahma Gargouri Mouna Snoussi Rym khemakhem Zouhir Bahloul Samy Kammoun <p>Non specific interstitial pneumonia (NSIP) is one of the most identified interstitial lung disease in antisynthetase syndrome. This case is about a 49 years old woman who presented with an exertional dyspnea that has a slow progression, with myalgia and arthralgia. Radiological findings suggested NSIP pattern. Auto antibodies were positive and no lung biopsy was performed. Eventhough there was a great improvement of the dyspnea under corticosteroid therapy, the patient developed mecanic’s hands, the anti-synthetase antibody (PL12) became positive and creatine phosphokinase (CPK) levels became high. Thus, antisynthetase syndrome was confirmed. After three years, the patient follow up showed an improvement of symptoms under corticosteroid therapy</p> Copyright (c) MALE - CATASTROPHIC ANTIPHOSPHOLIPID ANTIBODY (CAPS) SYNDRONME 2021-07-26T04:21:51+00:00 Dr Mukesh Bairwa Paras Gupta Jithesh G Ravi Kant <p>Antiphospholipid antibody syndrome leads thrombophilia manifest as venous and arterial thrombosis with pregnancy loss in the presence of persistent antiphospholipid antibody. It’s a disease is which is more common in female. CAPS is the fatal variant of APS in which 3 or more organs are involved with multi-organ failure in a short period of time with high rate of morbidity and mortality.</p> <p>We present an unusual case of south-east Asian young male who’s a known case of leprosy on treatment presented with multiple left renal infarcts, multiple splenic infarcts, pulmonary thromboembolism, and inferior mesentery artery thrombosis with bowel ischemia. Patient have positive B2GP1 antibodies, dilute Russell`s viper venom. In spite of start on low molecular weight heparin, anti-platelets and intravenous immunoglobulin (IV Ig) patient could not be survived. The aim of the case presentation is to remember the clinical scenario, lab parameter and aggressive management required in the case of patient in ICU.</p> Copyright (c)