135 Items


Dear Friends of EJCRIM,
we know that the COVID-19 epidemic is giving you a hard time. Please keep on fighting this virus, your efforts and work are irreplaceable in this very moment.

In order to spread awareness of the various COVID-19 manifestations, EJCRIM is now offering a Fast Track and the waiver of the publication fee for case reports and case series that touch this particular topic. The reports will be quickly peer-reviewed and published for free upon acceptance, so that the all internists and acute medicine doctors can take advantage of the immediate, shared knowledge.

Case reports are the quickest mean to share and to have your peers benefit from (vicarious) experience. Share yours.

The program will be in place until June, 1 2020. COVID-19 articles will be treated as fast track but not all submitted articles will be elegible for the fee waiver. Priority will be given to articles coming from the new epicentre, South America, as per WHO news conference held on Fri 22 May


Please do not hesitate to reach out to the Editorial Office in case of doubts.

All Items

  • Yuta Yoshino, Ken Tsuboi
    Views: 27 HTML: 1 PDF: 18

    Introduction: Large-scale clinical studies for COVID-19 vaccines have shown the infection-preventing effect and short-term adverse effects. Some rare illnesses such as eosinophilia can develop following COVID-19 vaccinations.
    Case description: We report a case of 65-year-old man with unexplained abdominal pain that developed 2 weeks after COVID-19 mRNA vaccination. The patient had received a second dose of COVID-19 mRNA vaccine and revealed eosinophilia at the first visit to our hospital. Eosinophil infiltration was observed in the lamina propria of the duodenum by a step biopsy. Montelukast 10 mg was administered as the initial treatment of eosinophilic gastroenteritis (EGE), and the abdominal pain was improved.
    Discussion: The strong influence of COVID-19 vaccination on the development of EGE remains unproven. Reports of eosinophilia following COVID-19 vaccination have discussed that COVID-19 mRNA vaccination triggered an eosinophilic response.
    Conclusion: This case presented EGE that developed following COVID-19 mRNA vaccination, which would be a rare adverse event.

  • Georgios Pilianidis, Georgia Papanastasiou, Pinelopi Tikoudi, Andreas Themistocleous, Georgios Farmakis, Konstantinos Dolianitis
    Views: 54 HTML: 4 PDF: 37

    Introduction: We present a case of anion gap euglycemic diabetic ketoacidosis (EuDKA) in a patient with COVID-19 infection. Patients with diabetes mellitus are at increased risk of severe illness, and hyperglycaemia is associated with higher morbidity and mortality in patients infected with COVID-19.
    Case Description: A 76-year-old male with diabetes mellitus treated with SGLT2 inhibitor tested positive for COVID-19 infection on day 3 after his admission. In the emergency room he had a high anion gap metabolic acidosis and a blood glucose of 248 mg/dl. His urine tested strongly positive for ketones. A diagnosis of euglycemic diabetic ketoacidosis was made and he was treated with intravenous insulin and normal saline; his antidiabetic medications were stopped. His metabolic acidosis gradually resolved, and he was discharged.
    Discussion: Euglycemic diabetic ketoacidosis is a rare complication of COVID-19 infection. It is defined by the American Diabetes Association as the triad of anion gap metabolic acidosis with arterial pH <7.3, serum bicarbonate <18 mmol/l and ketonuria or ketonemia. It is a life-threatening complication which usually occurs in type 1 diabetes mellitus patients but may also occur in type 2 diabetes mellitus patients. As described earlier, it is associated with hyperglycaemia but if blood glucose is low or near normal but <250 mg/dl it is then named euglycemic diabetic ketoacidosis. Patients treated with SGLT2 inhibitors are at increased risk of euglycemic diabetic ketoacidosis.
    Conclusions: COVID-19 infection precipitated euglycemic diabetic ketoacidosis in our patient. SGLT2 inhibitors must be stopped when this adverse reaction occurs. As their use increases, the risk of this adverse reaction is higher as well. Their prescription should be restricted to trained physicians who are able to educate their patients and treat them appropriately in situations that may arise.

  • Aris P. Agouridis, Evangelia E. Ntzani, Georgia Anastasiou, Fotios Barkas, Evangelos C. Rizos
    Views: 244 HTML: 10 PDF: 88

    Background: Beau's lines are transverse grooves in the nail plate that result from transient interruption of the growth of the proximal nail matrix. These rare nail disorders can be triggered mostly by infections or systemic diseases.
    Case Description: We describe a 65-year-old man who presented with nail changes on all fingernails. The patient, a non-smoker with no medication history, had severe immune responses during two hospitalisations, 9 and 4 months ago, for COVID-19. Both hospitalisations were accompanied by markedly elevated interleukin-6 levels, and treatment with tocilizumab on top of dexamethasone was required. The present examination revealed Beau's lines which were associated with both prior COVID-19 infections.
    Conclusions: Although nail changes look harmless, seeking Beau's lines during the physical examination might indicate past severe COVID-19 infection and a higher probability for reinfection and rehospitalisation.

  • Josef Finsterer, Sounira Mehri
    Views: 102 HTML: 7 PDF: 50
  • Toshitaka Sawamura, Shigehiro Karashima, Mitsuhiro Kometani, Ai Ohmori, Takashi Yoneda
    Views: 208 PDF: 83 HTML: 14

    Introduction: Individuals who have had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop post-coronavirus disease conditions, also known as long COVID. The symptoms of long COVID are nonspecific, and there are similarities between the symptoms of long COVID and those of Graves’ disease (GD). Therefore, it is important to rule out GD in patients suspected of having long COVID. Telemedicine is widely used to avoid the risk of SARS-CoV-2 infection. However, owing to the lack of in-person examinations, diagnostic errors can occur.
    Case description: A 27-year-old Japanese woman presented complaining of persistent fatigue, dyspnea, and low-grade fever, and after in-person examination was finally diagnosed with GD. She had been diagnosed with SARS-CoV-2 infection four months earlier and her symptoms had resolved within 5 days but then recurred. Subsequently, she had 3 telemedicine visits and had been diagnosed with long COVID.
    Discussion: With telemedicine there may be delayed diagnosis of GD in patients with a recent history of SARS-CoV-2 infection. Some symptoms and abnormalities cannot be confirmed in telemedicine visits performed using a simple mobile phone. Therefore it is important to know which findings obtained in telemedicine visits with a simple mobile phone are suggestive of GD. Low-grade fever and tachycardia are often observed in patients with GD, but rarely occur in patients with long COVID.
    Conclusion: Tachycardia and persistent low-grade fever after SARS-CoV-2 infection, which can be confirmed by telemedicine, can be clues for the diagnosis of GD. Therefore, in-person examination should be added if these symptoms are confirmed by telemedicine.

  • Josef Finsterer, Claudia Stöllberger
    Views: 135 HTML: 17 PDF: 68
  • Antonella Gallo, Francesca Ibba, Maria Grazia Massaro, Fiammetta Rognoni, Maria Cristina Giustiniani, Francesca Romana Ponziani, Massimo Montalto
    Views: 249 HTML: 21 PDF: 148

    Introduction: Recently, medical interest has been growing in SARS-CoV-2 infection and its multiorgan involvement, including the liver. Up until now, a few reports have described autoimmune hepatitis (AIH) triggered by SARS-CoV-2 infection, but no data are available about the specific liver inflammatory infiltrate and cluster of differentiation. We report a case of AIH triggered by SARS-CoV-2 infection, with a particular focus on its histological and mainly immunohistochemical features.
    Case description: A 60-year-old man, with a history of paucisymptomatic SARS-CoV-2 infection that occurred one month earlier, was admitted for alterations of hepatocellular necrosis and cholestasis indexes. He completed vaccination for SARS-CoV-2 a year earlier. The serologies for hepatotropic viruses were negative. The anti- smooth muscle antibodies (ASMA) and antinuclear antibodies (ANA) results were positive. Anti-liver kidney microsome (anti-LKM) antibodies and antimitochondrial (AMA) were negative. By liver biopsy, haematoxylin-eosin staining highlighted severe portal inflammation with a rich CD38+ plasma cell component, while immunohistochemical staining showed low cell CD4+ count and prevalence of CD8+ and CD3+. After biopsy, the patient started an immunosuppressant regimen, with benefit.
    Discussion: We can conclude that the patient developed a type 1 AIH triggered by SARS-CoV-2 infection. The presence of CD8 T-cells at immunohistochemical examination suggests different mechanisms from classic AIH. Similar cases are described after AIH triggered by SARS-CoV-2 vaccination.
    Conclusion: The AIH after SARS-CoV-2 infection developed by the patient showed a histological picture similar to a classic AIH for the abundant presence of plasma cells, and immunohistochemical features similar to those described after SARS-CoV-2-vaccination.

  • Riccardo Canta, Lucilla Vestito, Paola Castellini, Carlo Trompetto, Laura Mori, Anna De Giovanni, Luca Puce, Lucio Marinelli
    Views: 272 HTML: 28 PDF: 200

    Introduction: Dysphagia in post COVID-19 patients could be caused by several factors, including reduced pharyngolaryngeal coordination due to SARS-CoV-2 tropism to the central and/or peripheral nervous system. To our knowledge, this is the first reported case of COVID-19-related dysphagia successfully treated with botulinum toxin type A injection.
    Case description: We report the case of a patient with severe oropharyngeal dysphagia due to COVID-19 confirmed by fibre endoscopy. As a result, the patient required an enteral feeding tube. After two months of traditional swallowing therapies, there was only limited improvement. An electrophysiologic evaluation of the cricopharyngeal muscle was performed and showed a normal inhibition of the cricopharyngeal muscle, followed by a hypertonic rebound. Based on this result, we decided to perform a unilateral laryngeal injection of botulinum toxin type A. After the injection, the patient’s swallowing function improved significantly, allowing him to return to oral feeding.
    Discussion: Newly diagnosed oropharyngeal dysphagia was found in 35.3% of hospitalised patients with COVID-19. There are several possible causes of COVID-19-associated dysphagia, including stroke, encephalitis, critical illness neuropathy, Guillain-Barré syndrome and skeletal muscle injury. In our case, since stroke was excluded by brain MRI, cranial nerve injury was a possible explanation for the difficult recovery of swallowing despite daily swallowing therapy.
    Conclusion: We suggest that electrophysiology is a valid tool for the diagnosis and follow-up of patients with oropharyngeal dysphagia.

  • Helbies Bedier, Stéphane Isnard, Chelsea Maedler-Kron, Jean-Pierre Routy
    Views: 331 HTML: 33 PDF: 202

    Background: Castleman disease (CD) is a rare lymphoproliferative disorder with various subtypes, including the HHV-8-negative/idiopathic multicentric CD (iMCD). The diagnosis of iMCD remains challenging due to its non-specific presentation, in the form of generalised lymphadenopathies and inflammation. Two clinical presentations have been recently defined: a severe form iMCD-TAFRO and a milder form of iMCD not otherwise specified (iMCD-NOS). identification of interleukin-6 (IL-6) as a major culprit of inflammatory symptoms led to the development of anti-IL-6 therapies, with siltuximab being the approved first-line treatment.
    Case description: A 16-year-old male presented with recurrent fever, night sweats and several other non-specific symptoms. After extensive evaluations, an excisional lymph node biopsy confirmed the iMCD-NOS diagnosis. The patient received high-dose steroid therapy followed by siltuximab for four years. This treatment was well tolerated with only mild neutropenia not leading to dose adjustment. On siltuximab, the patient developed two mild COVID-19 episodes. His response to siltuximab remained effective throughout four years.
    Discussion: The absence of biomarker or causal agent identification poses a diagnostic challenge requiring lymph node histopathology for a definitive diagnosis of iMCD. Anti-IL 6 (siltuximab) is the recommended frontline therapy, suppressing inflammation and halting disease progression. Intravenous administration every 3 to 6 weeks can impact patient quality of life, prompting further research for alternative treatments. High-dose steroids, rituximab, cyclosporine, tacrolimus, lenalidomide or combined chemotherapy such as rituximab-bortezomib-dexamethasone are among the considered options according to disease severity.
    Conclusion: Overall, long-term siltuximab effectively controlled iMCD symptoms and was well tolerated by this young adult, who endured two mild COVID-19 episodes.

  • Anoop Kumar Pandey, Taleb Rooeintan
    Views: 474 HTML: 82 PDF: 378

    Spontaneous intracranial hypotension (SIH) is a rare cause of persistent headache, particularly among young and middle-aged people. A potentially life-threatening complication of SIH is a cerebral venous thrombosis (CVT). The authors present a case in which a patient presented with SIH complicated by CVT one week after receiving a booster dose of mRNA COVID-19 vaccine. According to our literature review, this is the first such case report.

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