European Journal of Case Reports in Internal Medicine 2020-08-12T19:17:43+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> Lymphatic filariasis, an endemic disease. 2020-08-12T19:17:43+00:00 Inês Ferreira <p>Filariasis is the most common cause of lymphedema in endemic countries. It is caused by parasites transmitted through mosquito bites. Elephantiasis is a late manifestation of lymphatic filariasis.</p> <p>We present the case of a 25-year old male with elephantiasis. Because the patient was from an endemic area, a diagnosis of chronic filariasis was made from clinical history and examination.</p> <p>Filariasis management includes use of antifilarial drugs in early stages, treatment and prevention of acute attacks (dermatolymphangioadenitis) through 'limb-hygiene' and antibiotics and where indicated, and physical measures to reduce the swelling.&nbsp;</p> Copyright (c) COVID-19 Precipitating Euglycemic Diabetic Ketoacidosis with SGLT2 Inhibitor Use 2020-08-12T06:02:23+00:00 Jiali Fang Matthew Genco Rachel Caskey <p><strong>Objective</strong></p> <p>To describe a patient who developed euglycemic DKA in the setting of SGLT2 inhibitor precipitated by COVID-19 infection</p> <p><strong>Patients and Methods</strong></p> <p>A 52-year-old male with type II diabetes on empagliflozin and no history of DKA presents with symptoms of COVID-19 as well as lab findings consistent with euglycemic DKA. His hospital course was complicated by recurrent episodes of euglycemic DKA as well as hyperglycemic DKA.</p> <p><strong>Conclusion</strong></p> <p>SGLT2 inhibitors should be held as early as possible during COVID-19 infection due to risk of euglycemic DKA. These patients should also have more intense glucose monitoring.</p> Copyright (c) Mondor’s disease: a rare diagnosis. 2020-08-11T17:30:09+00:00 Inês Ferreira <p>Mondor’s disease is a rare and self-limited disease, often underdiagnosed. is characterized by superficial thrombophlebitis of the subcutaneous veins of the thoracoabdominal wall.</p> <p>We present a case of a 38-year-old woman who presented with a tender and red mass in the thoracic wall. A diagnosis of Mondor’s disease was made based on the history and clinical findings.</p> <p>It is often idiopathic, but it can be secondary to trauma and breast surgery or cancer. Treatment is based in relieving symptoms.</p> Copyright (c) Invasive Pulmonary Aspergillosis in an Immunocompetent Patient. 2020-08-10T11:09:02+00:00 Francisco Silva Rita Morais Passos Francisca Silva Cardoso Miguel Romano Alexandra Esteves José Costa Carvalho Manuel Ferreira <p>Invasive Pulmonary Aspergillosis (IPA) is an opportunistic infection that usually threatens immunocompromised patients. However, there are some reports of IPA in immunocompetent patients without classic risk factors. We present the case of an 82-year-old woman with a prior medical history of chronic obstructive pulmonary disease (COPD) and a recent short-term corticosteroids regimen for an acute exacerbation. She was admitted with dyspnoea, cough and pleuritic pain and was diagnosed with pneumonia. Clinical deterioration occurred and a diagnosis of IPA was made. She received treatment with voriconazole but died 14 days after admission. This case highlights the importance of considering IPA among the possible causes of infection in this population. Prompt institution of appropriate antifungal therapy is paramount for the management of this condition.</p> Copyright (c) COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the Era of the COVID-19 Pandemic 2020-08-10T05:20:11+00:00 Taku Harada Takashi Watari Taiju Miyagami Satoshi Watanuki Taro Shimizu Juichi Hiroshige <p>Diagnostic errors are a severe problem in healthcare. The COVID-19 pandemic can cause healthcare workers to make their usually accurate decisions incorrectly, and the diagnostic process can be highly susceptible to cognitive bias. We report a case of aseptic meningitis that required five visits to be correctly diagnosed. This case highlights the risk of anchoring bias and the importance of reflecting our diagnostic process during the COVID-19 pandemic.</p> Copyright (c) Cutaneous angiosarcoma in an unusual location and without predisposing factors: a case report 2020-08-08T08:47:09+00:00 Ana Oliveira Monteiro <p>&nbsp; Cutaneous angiosarcoma is a rare, highly malignant tumor of vascular endothelial origin. Usually arise in skin and superficial soft tissue, most on head and neck. It presents as a variety of lesions, considered the great mimicker, leading to a delay in diagnosis and evidencing the importance of biopsy with immunohistochemistry confirmation. There are few reports of extremities involvement in patients with pre-existing chronic lymphedema, or exposure to radiation therapy. We report a case of an 82-year-old woman with lower limb extensive cutaneous involvement, distant metastatic disease, and poor therapy response. Its rare location without predisposing factors highlights the need to raise awareness about this disease.</p> Copyright (c) Late worsening of COVID-19 pneumonia: successful treatment with ruxolitinib and steroid 2020-08-07T23:17:59+00:00 Mauro Betelli Fabio De Stefano Alberto Tedeschi <p class="western"><span style="font-family: Times New Roman, serif;">We describe the case of a patient hospitalized for the second time in a month due to delayed worsening of lung lesions in COVID-19 infection without bacterial superinfection. He was treated with hydroxycloroquine, iv steroid and ruxolitinib with rapid improvement of respiratory failure; one month after second discharge, mantaining low-dose oral prednisone, lung consolidations were significantly reduced at CT control.</span></p> Copyright (c) Fondaparinux-associated Thrombocytopenia: A Case Report 2020-08-07T18:52:26+00:00 Jahanzeb Malik Nismat Javed Muhammad Shoaib Asmara Malik Rana Abdul Sattar Hesham Naeem Matiullah Kamin <p>Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition causing thrombocytopenia and paradoxical thrombosis after exposure to heparin or low-molecular-weight heparin. It has been rarely reported by fondaparinux, an artificial pentasaccharide similar to heparin. This article presents a case of HIT associated with fondaparinux use.</p> Copyright (c) Cryptococcal necrotizing pneumonia with ARDS in a non-HIV patient 2020-08-05T14:41:04+00:00 Nolan HASSOLD Vincent IOOS Daniel DA SILVA Laurent LAINE <p>We report the first description of an association between cryptococcal pneumonia and severe ARDS. A twenty years old woman treated in hematology for a T/NK lymphoma was admitted in intensive care unit for acute respiratory distress syndrome. After initial improvement, a CT scan performed after secondary deterioration revealed a necrotizing pneumonia. A bronchoaspirate was positive for <em>Cryptococcus neoformans </em>var <em>neoformans</em>. Despite specific treatment, hypoxemia worsened requiring vv ECMO. The patient died one month later <strong>with necrotizing Cryptococcus pneumonia complicated with refractory ARDS, without other etiology of pneumonia</strong><strong>.</strong></p> <div id="mailtorapidetoModal" style="z-index: 20002;"> <div id="mailtorapidetoContentPopupModal"> <div id="mailtorapidetoModalPopupCloseMail">&nbsp;</div> <div id="mailtorapidemodalMailPopupQuestion">What do you want to do ?</div> <a id="mailtorapidebuttonNewApp"></a>New mail<button id="mailtorapidecopyClipboard">Copy</button><textarea id="mailtorapideselectAreaText"></textarea></div> </div> <div><img></div> <div id="mailtorapidetoModal" style="z-index: 20002;"> <div id="mailtorapidetoContentPopupModal"> <div id="mailtorapidetoModalPopupCloseMail">&nbsp;</div> <div id="mailtorapidemodalMailPopupQuestion">What do you want to do ?</div> <a id="mailtorapidebuttonNewApp"></a>New mail<button id="mailtorapidecopyClipboard">Copy</button><textarea id="mailtorapideselectAreaText"></textarea></div> </div> <div><img></div> Copyright (c) Sinonasal chondrosarcoma, an unusual location 2020-08-05T00:54:14+00:00 Vianney NDAYISHIMIYE Oumniya Abouhanine Merzem Aicha Belgadir Hasnaa Amriss Omar Moussali Nadia El Benna Naima <p><strong>Abstract</strong></p> <p><strong>Introduction</strong></p> <p>Chondrosarcoma is a tumor with a cartilaginous matrix frequently encountered in long bones and the pelvis with rare sinonasal location.</p> <p><strong>Patient and Methods</strong></p> <p>We report the case of a 25-year-old patient who was referred to us for an extension workup for sinonasal chondrosarcoma confirmed by anatomopathological examination.</p> <p><strong>Results</strong></p> <p>Facial magnetic resonance imaging (MRI) completed by CT scan noted an osteolytic tumor process of the hard palate and walls maxillary left sinus locally advanced.</p> <p>&nbsp;</p> <p><strong>Conclusion</strong></p> <p>The sinonasal location of a chondrosarcoma is rare. Characterized by cross-sectional imaging, its confirmation is histological</p> Copyright (c)