European Journal of Case Reports in Internal Medicine 2020-06-05T07:07:46+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> From Wellens To Kounis Syndrome: An Unlucky Patient 2020-06-05T07:07:46+00:00 Ossama Maadarani Zouheir Bitar Sania Shoeb Jadan Alsaddah <p>Wellens syndrome (WS) is identified by ECG changes in the precordial leads after resolution of angina chest pain. WS indicates critical stenosis of the proximal left anterior descending (LAD) artery. On the other hand, Kounis syndrome (KS) is an allergic reaction to various substances resulting in acute coronary syndrome. Contrast media can trigger the allergic reaction associated with KS. We describe a patient with WS who developed an allergic reaction to contrast media after percutaneous coronary intervention and experienced recurren myocardial infarction on re-exposure.</p> 2020-06-05T07:07:43+00:00 ##submission.copyrightStatement## Can Lung Ultrasound be Used to Screen for Pulmonary Embolism in Patients with SARS-CoV-2 Pneumonia? 2020-06-04T12:32:40+00:00 Andrea Boccatonda Eugenia Ianniello Damiano D'Ardes Giulio Cocco Fabrizio Giostra Claudio Borghi, Prof Cosima Schiavone, Prof <p>Thromboembolic disease is strongly associated with, or even an integral part of, COVID-19 pneumonia. Indeed, endothelial/microvascular damage to pulmonary capillaries seems to be the main trigger of the pneumonia. Here we report a case of pulmonary embolism in a COVID-19 patient with an atypical clinical presentation. Blood gas analysis and lung ultrasound allowed the correct diagnosis to be reached.</p> 2020-06-04T12:32:39+00:00 ##submission.copyrightStatement## Acquired Haemophilia A in Association with Influenza A and Urinary Tract Infection 2020-06-04T09:18:08+00:00 Felipe Peña-Muñoz Ernesto Parras Olga Compan Nora Gutierrez Celestino Martin Jose Ramon Gonzalez-Porras Jose Maria Bastida <p>Acquired haemophilia A (AHA) is a rare autoimmune disorder caused by an autoantibody against any circulating coagulation factor, especially factor VIII (FVIII). The lack of awareness of this condition suggests that diagnosis is a challenge and usually delayed, which leads to suboptimal treatment. Consequently, early diagnosis is mandatory to prevent potentially life-threatening bleeding complications. We present the case of an 85-year-old woman admitted to hospital with symptoms of respiratory infection who 12 hours later developed haematuria which required transfusion. Laboratory assays showed an isolated prolonged aPTT, a moderately reduced FVIII and a high inhibitor titre. Influenza A and <em>Escherichia coli</em> were also identified. Antivirals, antibiotics, immunosuppressive drugs and haemostatic agents were started. Two weeks later, the inhibitor was not detected, and bleeding and symptoms of infection had resolved. Immunosuppressive drugs were stopped on day 45 and there has been no recurrence since then. To date, no FVIII inhibitors have been reported in concomitant infection with influenza A and urinary <em>E. coli</em>. The identification of conditions potentially associated with AHA is essential to achieve complete remission.</p> 2020-06-04T07:30:40+00:00 ##submission.copyrightStatement## Multisystemic Infarctions in COVID-19: Focus on the Spleen 2020-06-04T09:18:08+00:00 Mariana Santos Leite Pessoa Carla Franco Costa Lima Ana Carla Farias Pimentel José Carlos Godeiro Costa Júnior Jorge Luis Bezerra Holanda <p>The literature suggests that COVID-19 provokes arterial and venous thrombotic events, although the mechanism is still unknown. In this study, we describe patients with confirmed coronavirus infection associated with multisystemic infarction, focusing on splenic infarction. More data are required to elucidate how COVID-19 and thrombotic disease interact and so that preventive and early diagnosis strategies can be developed.</p> 2020-06-03T12:24:14+00:00 ##submission.copyrightStatement## When the Treatment is the Cause: Disseminated Bacille Calmette–Guérin Infection 2020-06-04T09:18:08+00:00 Ana Teresa Marques Afonso Montserrat Rodríguez Framil Joaquín Sánchez Leira Néstor Vázquez Agra Federico García-Rodeja Arias <p>Bacille Calmette–Guérin (BCG) administration for superficial bladder cancer is a well-tolerated and very effective therapy. However, unpredictable systemic complications may occur on rare occasions. We present the case of a patient who attended for consultation because of fever, asthenia and weight loss following BCG immunotherapy. The clinical response to treatment and computed tomography scanning were key to diagnosis.</p> 2020-06-03T08:01:44+00:00 ##submission.copyrightStatement## COVID-19, Chronic Obstructive Pulmonary Disease and Pneumothorax: A Frightening Triad 2020-06-04T09:18:08+00:00 Erika Poggiali Andrea Vercelli Teresa Iannicelli Valentina Tinelli Laura Celoni Andrea Magnacavallo <p>We describe the case of a male patient admitted to our emergency department during the Italian COVID-19 epidemic, for progressive worsening dyspnoea. A diagnosis of pneumothorax and diffuse interstitial lung involvement was promptly made by lung ultrasound and confirmed by an HRCT scan. A chest CT scan also showed diffuse emphysema, as observed in chronic obstructive pulmonary disease (COPD), and small consolidations in the lower lobes, suggestive for COVID-19 pneumonia. A chest tube was immediately inserted in the emergency room with complete resolution of the dyspnoea. A nasopharyngeal swab for 2019-nCoV was positive. Unfortunately, the patient died from COVID-19-related acute respiratory distress syndrome after 48 days of hospitalization.</p> 2020-06-01T12:27:23+00:00 ##submission.copyrightStatement## Pulmonary MALToma Synchronous with Metastatic Prostate Adenocarcinoma: A Diagnostic Challenge 2020-06-04T09:18:08+00:00 Aaron Braddy Rahul Janardan Mogal Anthony John Maddox Andrew Bryan Timothy Barlow <p><em>Objectives:</em> We describe the novel case of a patient presenting with pulmonary mucosa-associated lymphoid tissue lymphoma (pMALToma) synchronous with metastatic prostate adenocarcinoma. <br> <em>Materials and methods:</em> We report the clinical, laboratory, radiological and histological findings of the above patient.<br> <em>Results:</em> While the patient’s metastatic prostate adenocarcinoma responded well to chemo-radio-hormonal therapy, a persistent area of lung consolidation was noted and further investigated, leading to the diagnosis of concurrent pMALToma. <br> <em>Conclusion:</em> It is important to pursue further investigation when there appears to be persistent change or altered disease response in malignancy if there is evidence for disease response elsewhere, as there may be two synchronous primary cancers.</p> 2020-06-01T07:44:31+00:00 ##submission.copyrightStatement## Contrast-Induced Rhabdomyolysis Occurring after ERCP in a Patient with Pancreatic Cancer: A Case Report 2020-05-29T14:15:33+00:00 Natassja Moriarty Jonathan Moriarty John Keating <p><em>Objective:</em> We present a patient with pancreatic cancer who developed weakness, acute renal failure and significantly raised creatine kinase levels post-ERCP and who was assessed as having contrast-induced rhabdomyolysis.<br> <em>Results:</em> The patient underwent haemofiltration and ultimately succumbed to his condition.<br> <em>Conclusion:</em> Rhabdomyolysis is a potentially life-threatening condition which occurs because of damage to skeletal muscle, with release of myoglobin and electrolytes into the circulation. The mortality rate is 59% in severe cases, despite appropriate treatment.</p> 2020-05-29T07:24:07+00:00 ##submission.copyrightStatement## Bilateral Subdural Haematoma and CPAP Use: A Possible Association 2020-05-29T14:15:33+00:00 Beatrice Khater Vicky Kassouf Georges Haddad Roula Hourany <p>Obstructive sleep apnoea (OSA) is a common condition usually treated with continuous positive airway pressure (CPAP). No reports have linked it to an acute subdural haematoma. A 54-year-old white man who had hypertension well controlled with an angiotensin II receptor blocker, presented with a 2-week history of occipital headache with no other focal neurological symptoms. The headache began 12 days after he had started using CPAP for OSA. A brain MRI performed 2 weeks later showed bilateral subdural haematomas which were chronic on the left and sub-acute/acute on the right. Since the patient was clinically stable with no focal neurological deficits, he received prednisone for 3 weeks and was followed up with consecutive CT scans demonstrating gradual regression of the haematomas. This is the first report showing that subdural haematomas could be linked to CPAP use.</p> 2020-05-28T07:19:47+00:00 ##submission.copyrightStatement## Intermittent Pacemaker Malfunction Caused by Continuous Compression of the Lead by the Clavicle (Subclavian Crush Syndrome) 2020-05-29T14:15:33+00:00 Ardian Rizal Evit Ruspiono Dinarsari Hayuning Putri <p>Subclavian vein access is still one of the most favoured access options for cardiac implantable electronic device (CIED) implantation. For the physician, the technique is reasonably familiar and easy to carry out. However, this has several potential complications. In this case, we present a late complication of subclavian access. The patient presented with intermittent loss of pacemaker output, which caused him to experience several syncopal events. In the acute setting, we changed the lead polarity and achieved a good outcome. Further management of this situation consisted of removal and replacement of the damaged lead.</p> 2020-05-27T08:29:24+00:00 ##submission.copyrightStatement##