https://ejcrim.com/index.php/EJCRIM/issue/feed European Journal of Case Reports in Internal Medicine 2020-10-28T18:47:30+00:00 Editorial Office ejcrim@smc-media.eu 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="http://www.efim.org/about/member-countries">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> https://ejcrim.com/index.php/EJCRIM/article/view/2105 SCLERODERMA SPECTRUM DISEASES: GENERALIZED MORPHEA 2020-10-28T18:47:30+00:00 Sara Joana Faria sarajoanafaria@gmail.com Ana Sofia Costa asf.costa@gmail.com Teresa Faria Mendonça teresa.faria.mendonca@gmail.com <p>We present a clinical case of an 82-year-old man who developed progressive thickening of the skin (thighs, abdominal wall, trunk and limbs) and thoraco-abdominal discomfort due to the extrinsic compression. At physical examination we noted the presence of morpheaform plaques – confluent, non-symmetrical, some sclerotic and others atrophic, with poorly defined erythematous border areas, involving more than 80% of the body surface. Immunological markers, other than Antinuclear Antibodies (ANA), and systemic involvement were negative. Clinical findings favored Generalized Morphea and the skin biopsy confirmed it. Patient started Prednisolone (PDN) 1mg/kg/day at weaning, with symptomatic improvement.</p> <p>Morphea is a connective tissue disorder of unknown etiology and poorly understood pathogenesis. Despite the cutaneous involvement with sclerosis, morphea must be distinguished from Systemic Sclerosis (SSc) wich has frequent internal organ involvement. Raynaud’s phenomenon, gastrointestinal disease (early signs of SSc), sclerodactyly, telangiectasia, digital ulcers, puffy fingers, and facial sclerosis are usually absent in Morphea.</p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2104 Nail sarcoidosis presenting with onychorrhexis and longitudinal erythronychia 2020-10-28T09:31:16+00:00 Dimitra Koumaki dkoumaki@yahoo.gr Vasiliki Koumaki vkoumaki@yahoo.com George Evangelou gevag600@yahoo.co.uk Alexander Katoulis alexk12@yahoo.com Nikolaos Galanakis nikos_meduoc@hotmal.com Vrettos Haniotis vrethan@gmail.com Konstantinos Krasagakis kras12@yahoo.com <p>Sarcoidosis is a granulomatous disease characterized by the presence of noncaseating granulomas in organs and tissue affecting multiple systems, and cutaneous involvement is seen in 10–35% of cases. Involvement of the nail is rare, and occurs usually in patients with chronic sarcoidosis. We present a rare case of a 17-year-old patient with cutaneous and nail sarcoidosis with longitudinal erythronychia and onychorrhexis.</p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2103 Generalized lichen planus-like eruption related to trimebutine 2020-10-27T17:56:38+00:00 Dimitra Koumaki dkoumaki@yahoo.gr Vasiliki Koumaki vkoumaki@yahoo.com Alexander Katoulis alexk12@yahoo.com Sotirios Boumpoucheropoulos sotboubou90@gmail.com George Evangelou gevag601@gmail.com Maria Stefanidou stefm11@yahoo.com Konstantinos Krasagakis kras12@yahoo.com <p>Trimebutine is a &nbsp;spasmolytic agent with antimuscarinic effects that is used for the treatment of irritable bowel syndrome (IBS) and lower gastrointestinal tract motility disorders. Lichenoid drug eruptions(LDE), to trimebutine maleate have not previously been reported. Here we present the case of a 50-year-old male patient who developed and extensive lichenoid eruption on his upper and lower extremities and trunk four weeks after starting treatment with trimebutine maleate 300mg once daily for IBS. Two months after discontinuation of the drug and topical tretament with emollients and corticosteroids, the LDE cleared completely with no recurrence. The diagnosis of LDE due to trimebutine was made, based upon&nbsp; the clinical features resembling lichen planus, the histologic findings of interface dermatitis, the evidence of temporal relationship between drug intake and development of skin lesions and resolution upon discontinuation fo the drug. To the best of the authors’ knowledge lichenoid drug eruption (LDE) following trimebutine maleate intake has never been reported. Management of trimebutine-induced lichenoid drug eruptions includes withdrawal of the causative agent and treatment with potent topical corticosteroids.</p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2102 First experimental clinical case of an automated detection platform for situations at risk of geriatric decompensation 2020-10-27T11:10:55+00:00 Abrar-Ahmad ZULFIQAR abrar-ahmad.zulfiqar@chru-strasbourg.fr Orianne Vaudelle orianne.vaudelle@predimed-technology.com Mohamed Hajjam mohamed.hajjam@predimed-technology.com Dominique Letourneau dletourneau@fondationdeavenir.org Jawad Hajjam jawad.hajjam@centich.fr Sylvie Ervé sylvie.erve@centich.fr Anna Karen Garate Escamilla kren.garate@gmail.com Amir Hajjam amir.hajjam@utbm.fr Emmanuel Andrès emmanuel.andres@chru-strasbourg.fr <p>&nbsp;</p> <p style="margin: 0cm -0.1pt 0pt 0cm; text-align: justify; line-height: normal;"><span style="font-size: medium;"><strong><span lang="EN-US" style="font-family: 'Cambria','serif'; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US;">Introduction&nbsp;:</span></strong><span lang="EN-US" style="font-family: 'Cambria','serif'; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> We experimented with the e-platform MyPredi - dedicated to the automated, intelligent detection of situations at risk of decompensation of geriatric syndromes.</span></span></p> <p>&nbsp;</p> <p style="margin: 0cm -0.1pt 0pt 0cm; text-align: justify; line-height: normal;"><span style="font-size: medium;"><strong><span lang="EN-US" style="font-family: 'Cambria','serif'; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US;">Objective</span></strong><span lang="EN-US" style="font-family: 'Cambria','serif'; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">: the goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPredi platform, through its daily use. </span></span></p> <p>&nbsp;</p> <p style="margin: 0cm -0.1pt 0pt 0cm; text-align: justify; line-height: normal;"><span style="font-size: medium;"><strong><span lang="EN-US" style="font-family: 'Cambria','serif'; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US;">Results:</span></strong><span lang="EN-US" style="font-family: 'Cambria','serif'; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> The telemedicine solution made 3,552 measurements for the patient throughout her hospitalization, with an average of 237 measurements per day. The telemedicine solution issued 32 alerts for the patient during her stay, with an average of 2 alerts per day. Heart failure was the main geriatric risk that generated the most alerts (n=13). In terms of sensitivity, the results are 100% for all geriatric risks, and very satisfactory in terms of positive and negative predictive value.</span></span></p> <p><strong><span lang="EN-US" style="line-height: 115%; font-family: 'Cambria','serif'; font-size: 11pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Conclusion:</span></strong><span lang="EN-US" style="line-height: 115%; font-family: 'Cambria','serif'; font-size: 11pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Calibri; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"> The present experiment shows through its realization the relevance of the technological choices, the tools and the solutions developed.</span></p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2101 Ulcerative necrotic skin changes of the penis similar to Fournier's gangrene after homosexual oral sex with a two-hour use of a throttling rubber ring to maintain an erection and after an interval of four days with repeated intense self-masturbation. 2020-10-27T09:16:28+00:00 VINCENT NAGY vincent.nagy@upjs.sk <p>We present a patient with ulcerative necrotic skin changes after oral homosexual sex. To maintain the erection he used a vasoconstrictive, commercially available rubber ring that was applied to the penis and scrotum for more than two hours. The ring caused ischemia and thrombosis of small and medium-sized veins, later ulcerative necrotizing and inflammatory changes of the skin of the penis with infection as in acute balanoposthitis. The condition initially resembled Fournier's gangrene without involvement of the fascia or deeper structures of the penis. After the wound healed, a permanent defect of the skin with a scar remained.</p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2100 Self-Expandable Transcatheter Aortic Valve Frame Infolding: An Increasingly Recognized Complication 2020-10-25T23:27:45+00:00 Gurpreet Singh singh.gurpreet@mayo.edu Vien Le le.vien@mayo.edu Robert Wiechmann wiechmann.robert@mayo.edu Steven Schreiter schreiter.steven@mayo.edu <p class="Normal1" style="margin-bottom: .0001pt; line-height: 24.0pt;"><span style="font-size: 12.0pt; font-family: 'Times New Roman','serif';">Transcatheter aortic valve replacement (TAVR) with either balloon-expandable or self-expandable transcatheter heart valve (THV) is an approved therapy for patients with symptomatic severe aortic stenosis and high or intermediate surgical risk. We present here a case of severe valve frame infolding of a CoreValve Evolut PRO<sup>®</sup> self-expandable THV (Medtronic Inc.), which was restored to optimal geometry with balloon post dilation.</span></p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2099 THE USE OF THALIDOMIDE IN SEVERE REFRACTORY ANEMIA DUE TO GASTRIC ANTRAL VASCULAR ECTASIA (GAVE) IN CIRRHOSIS 2020-10-25T01:49:39+00:00 Marcelo Aveiro marceloaveiro90@gmail.com Tatiana Rodrigues regitatirodrigues@hotmail.com Tiago Rabadão tiago25051@hotmail.com Filipa Ferreira afilipa.csferreira@gmail.com Mariana Teixeira marianadealmeidateixeira@gmail.com Ana Oliveira oliveira.anacr92@gmail.com Inês Vasconcelos mines.vasc@gmail.com <p>Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding associated with cirrhosis. The first-line treatment is endoscopic therapy with argon plasma coagulation (APC). Because of the high recurrence rate, some evidence suggest that thalidomide could play an important role in controlling refractory anaemia due to GAVE. &nbsp;The authors present the case of a cirrhotic patient with recent diagnosis of GAVE, submitted to multiple endoscopic treatments and blood transfusions due to hematemesis. The patient started thalidomide and 6 months after, there was no recurrence of hematemesis and haemoglobin levels were stable, with no reported adverse effects.</p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2098 A case of stridor after SARS-CoV-2 pneumonia 2020-10-24T14:00:50+00:00 Joana Rodrigues dos Santos joanaorsantos@gmail.com Catarina Oliveira catarinasdeoliveira@gmail.com Tânia Vassalo vassalo.tania@gmail.com Ryan Costa Silva ryansilva@campus.ul.pt Tiago Lourenço Coelho tlourenco.coelho@gmail.com Lígia Peixoto ligia_peixoto@yahoo.com.br <p>SARS-CoV-2, the novel coronavirus, is the causative agent of a major outbreak. The known severity of COVID-19 disease ranges from mild symptoms of upper respiratory tract infection to severe pneumonia. Much is left to understand about the natural course of the disease as well as about the complications that may arise, even after there are criteria for cure.</p> <p>We present the case of a patient who developed severe airway edema after SARS-CoV-2 infection, simulating a bilateral paralysis of the vocal folds, needing orotracheal intubation for airway protection and after that a tracheotomy.</p> <p>The authors believe that the persistence of severe cough after COVID-19 disease may have been responsible for the severe edema, leading to upper respiratory distress requiring tracheotomy.</p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2096 Tension pneumomediastinum complicating Pneumocystis jirovecii pneumonia 2020-10-22T12:02:27+00:00 Débora Sousa dsofia.sousa@gmail.com Susana Carvalho Coelho sccoelho@hospitaldaluz.pt Alexandra Bayão Horta ahorta@hospitaldaluz.pt <p>Pneumomediastinum is a rare complication of <em>Pneumocystis jirovecii</em> pneumonia. It can evolve into a tension pneumomediastinum, which is a potential life-threatening complication.</p> <p>We report the case of a 40-year-old man admitted in the emergency department with a 15-day history of fever, dyspnea and dry cough. Arterial blood gas analysis revealed significant hypoxemia and the chest radiograph showed diffuse interstitial bilateral lung infiltrates. He tested positive for human immunodeficiency virus 1 and after bronchoalveolar lavage analysis a diagnosis of <em>Pneumocystis jirovecii</em> pneumonia was established. On day-14 of treatment the patient complained of chest tightness and had an acute deterioration in his oxygen saturation. Physical examination revealed swelling and crepitus of the neck and thorax and computed tomography showed an exuberant pneumomediastinum. The patient’s clinical condition deteriorated and required mechanical ventilation, which in turn worsened the pneumomediastinum with progression into a tension pneumomediastinum with hemodynamic instability, requiring emergent mediastinal drainage. Despite medical treatment and extensive ventilatory support the patient died on the 30<sup>th</sup> day of hospitalization.</p> Copyright (c) https://ejcrim.com/index.php/EJCRIM/article/view/2097 Isolated TET2 Positive in Triple Negative Essential Thrombocytosis - Case Report and Literature Review. 2020-10-21T16:01:43+00:00 Rehab yusuf AL-Ansari dr_rehab10000@hotmail.com Dena Al Otaibi Dena.ossaimi@gmail.com Nourah Al Hudaithi Noura.hu1@gmail.com Leena Abdalla leenamgy@gmail.com <p>&nbsp;</p> <p dir="RTL" style="margin: 0cm 0cm 8pt; text-align: left;" align="right"><span style="font-size: medium;"><span dir="LTR"><span style="font-family: Calibri;">Essential Thrombocytosis (ET) is one of the famous diseases under the category of myeloproliferative disorder (1). It is an end result of </span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">a </span><span dir="LTR"><span style="font-family: Calibri;">genetic mutati</span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">on of </span><span dir="LTR"><span style="font-family: Calibri;">one or more of the most frequent oncogenes </span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">such </span><span dir="LTR"><span style="font-family: Calibri;">as</span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;"> (Janos kinase 2)</span><span dir="LTR"><span style="font-family: Calibri;"> JAK2, MPL &amp; CALR. <span style="mso-spacerun: yes;">&nbsp;</span>However, negative genetic markers,</span></span> <span dir="LTR"><span style="font-family: Calibri;">so called (triple negative disease)</span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">, </span><span dir="LTR"><span style="font-family: Calibri;">can happen</span></span> <span dir="LTR"><span style="font-family: Calibri;">and this require</span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">s</span><span dir="LTR"><span style="font-family: Calibri;"> further screening for </span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">other </span><span dir="LTR"><span style="font-family: Calibri;">infrequent</span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">ly</span><span dir="LTR"><span style="font-family: Calibri;"> affected genes. </span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">TET2 (Ten-eleven translocation 2)</span><span dir="LTR"><span style="font-family: Calibri;"> positive as isolated genetic marker in triple negative Essential Thrombocytosis is uncommon genetic presentation (2). For that, we are reporting a 22 years old lady who presented with feature of dyspepsia and </span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">accidentally found </span><span dir="LTR"><span style="font-family: Calibri;">to</span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;"> have </span><span dir="LTR"><span style="font-family: Calibri;">persistently high </span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">platelet count, </span><span dir="LTR"><span style="font-family: Calibri;">even after treating her mild iron deficiency anemia with no other secondary causes. Further investigations and bone marrow biopsy supported the diagnosis of </span><a name="_Hlk40632198"></a><span style="font-family: Calibri;">isolated T</span></span><span style="mso-bookmark: _Hlk40632198;"><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">ET</span></span><span style="font-family: Calibri;"><span style="mso-bookmark: _Hlk40632198;"><span dir="LTR">2 positive in triple negative Essential Thrombocytosis</span></span><span dir="LTR">. we treated her conservatively with </span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">good hydration </span><span dir="LTR"><span style="font-family: Calibri;">and low dose of aspirin. In conclusion, </span><a name="_Hlk54197003"></a><span style="font-family: Calibri;">isolated </span></span><span style="mso-bookmark: _Hlk54197003;"><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">TET</span></span><span style="font-family: Calibri;"><span style="mso-bookmark: _Hlk54197003;"><span dir="LTR"> 2 positive in triple negative Essential Thrombocytosis at presentation is un common</span></span><span dir="LTR"> and there is no clear guidance for how to categorize and risk stratif</span></span><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;">cation of </span><span dir="LTR"><span style="font-family: Calibri;">patients with such presentation. </span></span></span><a name="_Hlk40630278"></a><span dir="LTR" lang="EN-GB" style="color: black; font-family: 'Times New Roman',serif; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB;"><span style="font-size: medium;">Moreover</span></span><span style="font-family: Calibri;"><span style="font-size: medium;"><span style="mso-bookmark: _Hlk40630278;"><span dir="LTR">, no guidelines in how to manage this group of patients and whether cytoreduction agent is indicated or not. </span></span><span dir="LTR">Further study and guidelines required in this area.<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span></span></p> <p>&nbsp;</p> Copyright (c)