European Journal of Case Reports in Internal Medicine 2021-04-13T03:47:06+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> Non-Severe Pneumonia COVID-19 Complicated by Deep Vein Thrombosis (DVT) 2021-04-13T03:47:06+00:00 Wulyo Rajabto Dimas Priantono <p><strong>Introduction: </strong>Coronavirus Disease 2019 (COVID-19) displays various symptoms ranging from asymptomatic to life threatening. Patients may present with typical respiratory infection or atypical symptoms.&nbsp; We presented a COVID-19 case with chief complaint of unilateral leg swelling.</p> <p><strong>Case Presentation:</strong> A 48-year-old male was admitted to with chief complaint of cramp and swelling of the left leg. He had history of fever, cough, nausea, and vomiting. Laboratory studies showed elevated D-dimer. Doppler ultrasound shows signs of both proximal and distal deep vein thrombosis.&nbsp; CT pulmonary angiography excluded pulmonary embolism while the lung window image supported the diagnosis of COVID-19 pneumonia.&nbsp; Polymerase chain reaction (PCR) obtained from nasopharyngeal and oropharyngeal swabs confirmed COVID-19 infection. We treated the patient with parenteral anticoagulation followed by direct oral anticoagulant upon discharge.&nbsp; The swelling improved as well as the patient’s clinical status.</p> <p><strong>Discussion: </strong>Thromboembolic complications has been credited as the culprit of high mortality in COVID-19.&nbsp; Systemic activation of coagulation in pulmonary and peripheral circulation contributed to life-threatening thrombotic complication.&nbsp; Our patient presented with COVID-19 associated proximal and distal DVT without pulmonary embolism.&nbsp; Treatment guidelines recommend the use of parenteral anticoagulants followed by extended oral anticoagulant therapy.</p> <p><strong>Conclusion: </strong>Prompt diagnosis of COVID-19 infection and acute DVT improves patient care. The hallmark of the management of VTE in COVID-19 patients is treatment with therapeutic dose parenteral anticoagulation followed by oral anticoagulant.</p> Copyright (c) Diagnostic and management errors in an immunodeficient patient with pneumococcal pneumonia with bacteremia due to incorrect assessment of the patient’s immune status 2021-04-12T09:37:53+00:00 Takahiro Ito Yukinori Harada Taro Shimizu <p>A 79-year-old woman presented with fever and pleural chest pain. Based on the assessment of mild community pneumonia in an immunocompetent state, the outpatient follow-up was planned; however, she was admitted several hours later with a diagnosis of pneumococcal pneumonia with bacteremia. Besides, selective immunoglobulin M deficiency was detected. In this case, although a history of recurrent osteomyelitis was provided, the physicians overlooked the information suggesting immunodeficiency, which led to incorrect diagnostic and management decision. Obtaining past medical history is essential, but utilizing it is even more important to avoid clinical decision-making errors.</p> Copyright (c) A rare cause of exocrine pancreatic insufficiency 2021-04-10T23:42:16+00:00 MOHAMED LABIED <p>Lipomatous pseudohypertrophy (LPH) of the pancreas is an uncommon affection of exocrine pancreatic insufficiency. It’s defined as a substitution of the pancreatic exocrine gland by a large fat component. We report the case of a young patient with malabsorption syndrome (chronic diarrhea and steatorrhea), trouble in biological assessment and normal fibroscopy. Computed tomography had found diffuse pancreatic characteristic abnormalities.</p> Copyright (c) Gemfibrozil Induced Polyuria: A Case Report 2021-04-09T17:03:28+00:00 Ashraf Ahmed Edmond Okotcha Abdulhassan Saad <p><strong>Abstract:</strong></p> <p>Gemfibrozil is a lipid regulating agent used mainly to treat patients with hypertriglyceridemia, especially those at risk for acute pancreatitis. Like any other pharmacological agent, gemfibrozil has known adverse effects, mainly gastrointestinal, like cholelithiasis, gallstones, elevated transaminase, and other nonspecific symptoms; dyspepsia, nausea, and vomiting. Other reported adverse reactions are dizziness and vertigo, myopathy and rhabdomyolysis, angioedema, urticaria, and rash. Up to our knowledge, gemfibrozil does not have urinary tract adverse reactions. In this report, we present a case of polyuria secondary to gemfibrozil scored 9 (definite) on Naranjo scale, with a literature review.</p> Copyright (c) SEVERE OSTEOPOROSIS AS ATYPICAL PRESENTATION OF HEREDITARY HEMOCHROMATOSIS 2021-04-09T15:02:59+00:00 Georgiana Cristina Taujan Laura Iconaru Mihaela Rosu Olga Ana Kosmopoulou Ioanna Blerta Papadopoulou Felicia Baleanu <p>Apart of important metabolic repercussions, iron overload is reported to be associated with deleterious effects on articulations and bones. We present you the case of a male patient diagnosed with severe osteoporosis with vertebral fracture, in whom the evaluation for secondary osteoporosis revealed hereditary hemochromatosis.</p> Copyright (c) Proteus Syndrome: a rare case in an adult ward 2021-04-09T13:41:23+00:00 Catarina Duarte Santos Rita Lizardo Grácio Tatiana Costa Pires Miguel González Santos Rita Jesus Rodrigues Miriam Magalhães Alcina Mota Ponte <p>Proteus syndrome is na extremely rare disorder that manifests as na asymetric, disproportionate overgrowth of any connective tissues, such as bone, fat, or epidermal nevi, in a mosaic or patchy pattern. It has as estimated prevalence of less than 1/1.000.000 live births. Because the phenotypes of the patients are variable, the diagnosis can be difficult. Many individuals develop cutaneous capillary malformation and prominent varicosities, large and complex vascular malformation. Thus, Proteus syndrome patients are at risk of developing deep venous trhombosis and pulmonary embolism. The author present the case of a patient with Proteus syndrome that was admitted because of a pulmonary thromboembolism, who presented hyperthrophy of the left arm and left hemithorax.</p> Copyright (c) Rapidly evolving perianal plasmablastic lymphoma masquerading as a Buschke-Löwenstein like tumor in an HIV infected patient with recurrent anal condyloma in the setting of antiretroviral therapy associated immune-reconstitution 2021-04-08T16:50:03+00:00 Joshua Baalwa Xavier Rivera Rivera <p>Background: Plasmablastic lymphoma arising in a background of refractory anal condyloma and following antiretroviral therapy immune reconstitution has not been previously described.</p> <p>Aim:&nbsp; We describe a case of plasmablastic lymphoma developing rapidly in the setting of refractory anal condyloma and masked by a Buschke-Löwenstein like tumor.</p> <p>Case description: A 34-year-old male presented with a history of anal condyloma, refractory to multiple fulguration. Five month prior to his diagnosis of lymphoma, he switched antiretroviral therapy due to persistent low CD4 counts. Three months prior to lymphoma diagnosis, he had fulguration and multiple biopsies of his rapidly enlarging condyloma, which revealed no evidence of lymphoma. Eventually he presented with a Buschke-Löwenstein like tumor and pathology revealed presence of condyloma with underlying plasmablastic lymphoma.</p> <p>Conclusion: &nbsp;A rapidly developing Buschke-Löwenstein like tumor&nbsp;should kindle a high index of suspicion for malignancy beyond the usual transformation of condyloma into an invasive squamous cell carcinoma.</p> Copyright (c) A 26-year-old Mother with Severe Ankle Pain after Delivery: A Case Report 2021-04-08T16:19:40+00:00 José Bernardo Ferreira Nuno Maia João Pedro Caetano Diana Fernandes Marília Rodrigues Simão Serrano <p>Background: Ankle tuberculosis is a rare condition and may develop after hematogenous dissemination from pulmonary origin.</p> <p>Patient and Methods: A 26-year-old mother presented with severe pain in the left ankle lasting for 3 months after delivery, associated with fever, ankle swelling and redness, with cold cyanotic forefoot.</p> <p>Results: Ankle radiograph and musculoskeletal ultrasound were obtained. Arthrocentesis revealed purulent liquid and emergent arthroscopic washout was performed. Pulmonary and osteoarticular tuberculosis diagnosis were established after positive mycobacterial cultures.</p> <p>Discussion: This is the first case report of post-partum ankle tuberculosis. Early evaluation and treatment can be decisive prognostic factors.</p> Copyright (c) Bouveret’s syndrome: A curious case of gastrointestinal bleeding 2021-04-07T10:46:47+00:00 Andreia Vanessa Teixeira <div><span lang="EN-US">Bouveret’s syndrome is a rare biliary ileus due to gastroduodenal obstruction by gallstones, associated to high morbidity and mortality rates. Clinical manifestations and laboratory findings are non-specific. The aim of reporting this case is to emphasize clinical awareness for early diagnosis and treatment of this infrequent clinical syndrome. </span></div> Copyright (c) A Case of Acquired Immunodeficiency Syndrome Related Kaposi Sarcoma in a patient with COVID-19- A Therapeutic Dilemma 2021-04-07T00:10:31+00:00 Adeel Nasrullah Samir Patel Mian Tanveer Ud Din Anam Javed Hammad Arshad Atif Raja Tiffany Dumont <p><span style="font-family: 'Arial',sans-serif; color: black;">Untreated Human Immunodeficiency virus (HIV) can result in various superimposed infections and malignancies such as Kaposi sarcoma (KS), an acquired immunodeficiency syndrome (AIDS) defining illness. AIDS-related KS is a vascular tumor which is seen in association with Human Herpes Virus-8 (HHV-8). It can manifest as painless violaceous lesions involving mucocutaneous tissues or multiple organs. Radiologically KS can present with diffuse grand glass opacities and consolidations in the peribronchovascular regions. Management of limited AIDS-related KS typically includes combined antiretroviral therapy (ART) while multi-organ KS disease demands systemic chemotherapy. Immunosuppression should be avoided in patients with AIDS-related KS as it can lead to progression of KS. Co-infection of Coronavirus disease-19 (COVID-19) and AIDS-related KS can complicate the management of KS as steroids are the main stay of therapy for COVID-19 pneumonia. The prognosis of AIDS-related KS depends on the stage of disease. Disseminated KS has a 5-years survival of 41%. We report a novel case of AIDS-related disseminated KS in a young patient with concomitant COVID-19 infection who developed multiorgan failure requiring tracheostomy, renal replacement therapy, and a prolonged intensive care unit (ICU) stay.</span></p> Copyright (c)