European Journal of Case Reports in Internal Medicine <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> en-US <h3>Copyright and Disclosures</h3> <p>Every author must sign a copyright transfer agreement and disclose any financial or professional interest in any company, product, or service mentioned in an article. This authorization includes all submitted text including illustrations, tables, and other related materials.<br> If this submission contains any <strong>material that has been previously published</strong>, this authorization <strong>must also be accompanied</strong> by all necessary Permission to Reproduce Published Material" forms completed by the current copyright owner. If this submission contains any <strong>previously unpublished material</strong> for which the person(s) signing this form <strong>does not own copyright</strong>, an additional "Authorization to Publish" form is required from each corresponding copyright owner.</p> <h3>Copyright Transfer Declaration</h3> <p>(this may be included as a word document with your manuscript submission)<br> I confirm that I am the current copyright owner of the material described above and hereby transfer and assign to the European Journal of Case Reports in Internal Medicine (EJCRIM) all copyrights in and to the material for publication throughout the world, in all forms and media, in English and in any other language(s). Such transfer includes publication in this and all future editions of the publication named above and in any other publications (including slide collections and any other nonprint media) of EJCRIM and gives EJCRIM the sole authority to grant rights for use of the material by others.<br> I waive EJCRIM from any liabilities connected to the incorrect copyright statement.<br>The copyright agreement form can be downloaded <a style="font-weight: bold;" href="/documents/EJCRIM_Copyright_auth.pdf">HERE</a> or requested to the editorial office <a style="font-weight: bold;" href=""></a></p> (Editorial Office) (Editorial Office) Mon, 08 Feb 2021 00:00:00 +0000 OJS 60 Investigating a febrile polyserositis <p>Hypereosinophilic syndrome (HES) describes a heterogenous group of diseases characterized by abnormal accumulation of eosinophils in the blood or peripheral tissues. It may affect all organs and therefore clinical manifestations are highly variable. We describe a case of a 38-year-old man admitted for febrile polyserositis. He developed cardiac tamponade requiring pericardiocentesis complicated by left ventricle perforation which was successfully repaired. He presented mild peripheral eosinophilia. Bronchoalveolar lavage evidenced eosinophilic alveolitis and pleural and pericardium histopathology revealed presence of abundant eosinophils. All other causes of tissue eosinophilia were excluded and diagnosis of idiopathic HES was made. The patient was started on glucocorticoids with resolution of symptomatology. This case presents a rare but potentially fatal presentation of HES and demonstrates the difficulty and delay in diagnosis when peripheral hypereosinophilia is absent. &nbsp;</p> Inês Rueff Rato, Joana Rigor, Paula Ferreira, Joana Laranjinha, Gualter Santos Silva, Daniela Martins-Mendes Copyright (c) Prostate Cancer and Reactive Hemophagocytic Lymphohistiocytosis <p>&nbsp;</p> <p style="margin: 0cm 0cm 0pt; text-align: justify; line-height: 150%; -ms-text-justify: inter-ideograph;"><span lang="EN-US" style="font-family: 'Arial',sans-serif; mso-ansi-language: EN-US;"><span style="font-size: medium;">We report the case of a 76-year-old man presenting a reactive Hemophagocytic Lymphohistiocytosis (rHLH) in the setting of a generalized prostate cancer. This highly lethal syndrome must be diagnosed early in order to maximize the survival rate. Treatment should be initiated whenever the clinical diagnosis is suspected, even if the HLH-2004 criteria are not met. The HScore is a useful diagnostic tool for rHLH. In case of neurological symptoms, an extensive assessment must be performed. The goal of this case report is to raise awareness among oncologists about this rare syndrome.</span></span></p> <p>&nbsp;</p> <p style="margin: 0cm 0cm 0pt; line-height: 150%;"><span lang="EN-US" style="font-family: 'Arial',sans-serif; mso-ansi-language: EN-US;"><span style="font-size: medium;">&nbsp;</span></span></p> <p>&nbsp;</p> <p style="margin: 0cm 0cm 0pt; line-height: 150%;"><span lang="EN-US" style="font-family: 'Arial',sans-serif; mso-ansi-language: EN-US;"><span style="font-size: medium;">Key Words : Prostate Cancer ; Reactive Hemophagocytic Lymphohistiocytosis ; Hyperferritinemia ; Pancytopenia ; Hypertriglyceridemia ; HScore</span></span></p> <p>&nbsp;</p> Laura Dumont, Adriano Salaroli, Lissandra Dal Lago, Thierry Gil, Thierry Pepersack Copyright (c) Efficacy of cannabinoids on spasticity and chronic pain in a patient with co-occurance of Multiple Sclerosis and Neurofibromatosis type 1. <p>Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disease involving the skin and central nervous system (CNS), but also skeletal and spinal schwannomas that may cause chronic neurogenic pain. Furthermore, pain in NF1 is underestimated, though having an impact on the quality of life. Multiple Sclerosis (MS) is the most common acquired demyelinating disease that may develop in later stages refractory spasticity, particularly in lower limbs<strong>.</strong> Oromucosal cannabinoid spray is currently available for spasticity treatment in MS, with encouraging results on MS pain, but few data are reported regarding the use of cannabinoids in NF1. We report the experience of successful treatment of chronic neurogenic pain and spasticity in a patient with co-occurrence of NF1 and MS after a poor response to standard approaches.</p> Eleonora Virgilio, Domizia Vecchio, Paola Naldi, Roberto Cantello Copyright (c) A case of pulmonary calcinosis associated with Alport syndrome <p>We report the case of a 48-year-old woman under dialysis from chronic renal failure (CRF) since the age of 27, due to Alport syndrome. The patient underwent routine chest X-ray on which diffuse micronodules were shown. Chest computed tomography showed partially calcified micronodules with centrilobular distribution respecting the subpleural spaces and predominant in the upper lobar regions. Diffuse pulmonary calcinosis was confirmed by the bone scan with an overall course of 29 years. This is the first reported case of pulmonary calcinosis from CRF due to Alport syndrome.</p> Valentine Mismetti, Marie-Pierre PERQUIS, Linda HAMDI, Marios E. FROUDARAKIS, Jean-Michel VERGNON Copyright (c) Successful use of a GLP-1 receptor agonist as add-on therapy to sulfonylurea in the treatment of KCNJ11 neonatal diabetes: a case report <p>Sulfonylurea monotherapy is the standard treatment for patients with the most common form of permanent neonatal diabetes, <em>KCNJ11 </em>neonatal diabetes<em>, </em>but not always sufficient. For the first time, we present a case of successful use of a GLP-1 receptor agonist as add-on therapy in the treatment of a patient with <em>KCNJ11</em> neonatal diabetes and insufficient effect of sulfonylurea monotherapy. Good glycemic control was maintained with a HbA1c level at 48 mmol/mol (6.5 %) at the end of 26 months follow-up.</p> Morten Hindsø, Christoffer Martinussen, Maria Saur Svane, Simon Veedfald, Birthe Gade-Rasmussen, Torben Hansen, Sten Madsbad Copyright (c) “AFTER ALL IT WAS NOT A LUNG CANCER - WHEN THE EVIDENCE IS MISLEADING” <p>The etiology of the pulmonary nodules is varied, the malignant ones are the most important, requiring rapid diagnosis and treatment.</p> <p>The clinical presentation and the imaging characteristics of the lesion may favor a specific diagnosis. However, several benign pathologies mimic more serious diseases.</p> <p>Man with left pleuritic chest pain, with ipsilateral spiculated nodular pulmonary image, assumed pneumonia and started antibiotic therapy. In the absence of improvement, positron emission tomography (PET) and transthoracic aspiration biopsy were performed, which diagnosed a lung cancer and the patient underwent an upper lobectomy. The anatomopathological study of the surgical specimen showed no malignancy.</p> <p>The diagnosis of pulmonary nodules preoperatively is, therefore, a challenge.</p> Joana Braga, Francisca Pereira, Cristiana Fernandes, Marinha Silva, Cristina Marques, Daniela Alves, Carlos Oliveira Copyright (c) Colonic Pseudo-obstruction as a Rare Complication of Pheochromocytoma <p>Colonic pseudo-obstruction is characterized by dilatation of the colon without structural lesion causing obstruction, which usually involves the cecum and right side colon. While it is commonly observed in patients with severe illness or after surgery, pheochromocytoma is a rare cause.</p> <p>Diagnosis of colonic pseudo-obstruction could be established by abdominal imaging including computed tomography (CT) of the abdomen or water-soluble contrast enema. It typically displays an intermediate transition at splenic flexure on radiography.&nbsp;</p> <p>In additional to conservative or surgical treatment according to guidelines, use of alpha-blockers could be considered in this setting to relieve the pseudo-obstruction.</p> KinWai SO, HoiLing Tsui, KimHung Tsang Copyright (c) Gonadotrophinoma as a stroke mimic <p>&nbsp;</p> <p>Objectives: to describe the case of a stroke mimic due to a gonadotrophinome. Pituitary adenomas don’t usually present this way</p> <p>Case description: 66-year-old man, former smoker, with a history of peripheral venous insufficiency. In the morning, he started to have difficulty drinking water, which led to recurrence to the Health Center. In neurological examination, he had deviation of the labial commissure to the right and right hemiparesis and hemihypostesia, having been sent to the Emergency Department (ER) as a stroke. In the ER, left ptosis was found and the deficits previously described were confirmed. CT scan showed an image compatible with pituitary macroadenoma. After discussion with Neuroradiology, differential diagnoses were placed between ischemic stroke without image translation and macroadenoma bleed. Given these hypotheses it was decided not to start anti-aggregation. It was discussed and the patient transferred to a neurosurgery referral center, where macroadenoma was confirmed by MRI. Histological study was compatible with gonadotropinome. Patient is followed up in an outpatient neurosurgery and endocrinology clinic. Of the neurological deficits, only left ptosis and deviation of the labial commissure persist.</p> Tiago Manuel Mendes, Sabina Azevedo, Joana Fontes, Joana Silva, Raquel Costa, Marta Pereira Copyright (c) Unusual presentation of the Covid-19 disease leading to respiratory distress and coma <p>Multiple reports of various neurological complications inclusive Guillain-Barré syndrome (GBS) have been associated with &nbsp;COVID-19 infection. We describe another Guillain-Baré (GBS) &nbsp;related with Sars-COVID-19 illness with unusual presentation beginning with mobilization problems at home without previous classical respiratory or general manifestations. An asymptomatic infection with COVID-19 can lead to critical situations with respiratory insufficiency &nbsp;because of neurological complications like GBS.</p> J. Paradis, H. Kevers, S. Chebli, S. Blum, P. Reper Copyright (c) Simultaneous vestibular, orbital, meningeal and medullary involvement in a patient diagnosed with neurofibromatosis type 2. <p><strong>Abstract</strong></p> <p><strong>Introduction</strong></p> <p>Neurofibromatosis type 2 (NF2) is an autosomal dominant genetic disease characterized by the presence of bilateral vestibular schwannomas.</p> <p><strong>Patient and methods</strong></p> <p>We report the case of a 21-year-old patient, followed up for neurofibromatosis type 2, operated two times for right parietal and orbital meningioma that complained for headache and dizziness, referred to us brain and cervical MRI exploration including 3D-FIESTA sequence.</p> <p><strong>Result</strong></p> <p>MRI completed by CT scan noted intraosseous and cerebral extra-axial meningiomas, bilatetal shwannomas and cervical epedymomas.</p> <p><strong>Conclusion</strong></p> <p>Neurofibromatosis type 2 is a genetic disease with nervous system lesions and MRI is important for their exploration.</p> Vianney NDAYISHIMIYE, Abouhanine Oumniya, Belgadir Hasnaa, Merzem Aicha, Amriss Omar, Moussali Nadia, El Benna Naima Copyright (c)