https://ejcrim.com/index.php/EJCRIM/issue/feed European Journal of Case Reports in Internal Medicine 2018-12-14T08:19:18+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/978 The Clinical Significance of a ‘Crazy-Paving’ Pattern on Chest Radiology 2018-12-14T08:19:18+00:00 Ahmed Ehab dr.a.ehab@gmail.com Radu I Braga radu.braga@klinikum-memmingen.de <p>A crazy-paving pattern is a non-specific radiological sign which is characterized by the presence of diffuse ground‐glass attenuation associated with interlobular septal thickening and intralobular lines. It was initially described as a pathognomonic sign of pulmonary alveolar proteinosis. However, it can be also found in many other diffuse acute and chronic lung diseases including diffuse alveolar haemorrhage (DAH), a rare and life-threatening clinical syndrome which can be caused by many conditions, the most frequent of these being capillaritis associated with systemic autoimmune diseases.<br> In this case report, we describe an 82-year-old female patient with acute respiratory failure and bilateral pulmonary infiltrates with the characteristic crazy-paving pattern. The final diagnosis was isolated DAH induced by microscopic polyangiitis. The patient was treated with IV high dose prednisolone and cyclophosphamide and was mechanically ventilated. Nevertheless, her clinical status progressively deteriorated and she died after 3 days from acute respiratory distress syndrome.</p> 2018-12-14T08:03:42+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/887 Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review 2018-12-12T08:41:06+00:00 Ana Patricia Castanheira Gomes an.patricia.gomes@gmail.com Eduardo Cernadas cernadas.eduardo@gmail.com Juliana Sá julianampsa@gmail.com Helena Brito helenabri@hotmail.com Ricardo Costa an.patricia.gomes@gmail.com <p>Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage.</p> 2018-12-12T08:25:17+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/1000 A Reflection on the Use of Enoxaparin Based on Three Case Reports 2018-12-10T12:05:41+00:00 Rui Costa ruikossta@gmail.com Inês Ferreira ictgferreira@gmail.com Inês Egídio De Sousa inesegidiosousa@gmail.com Mariana Martins marianamartins1989@gmail.com Carolina Gouveia carolina.n.gouveia@gmail.com Patrícia Vicente aprvicente@gmail.com Ana Pedroso ana.pedroso.pt@gmail.com <p>Enoxaparin is indicated for the treatment or prevention of many clinical disorders including deep vein thromboembolism, atrial fibrillation and mechanical valve thrombosis. It is one of the most commonly prescribed drugs in hospitals. However, haemorrhagic complications can occur, particularly in the elderly, patients with renal function impairment and patients with a very high or very low body weight. The authors describe the cases of three patients who had one or more risk factors for haemorrhagic complications, such as abdominal haematomas. The clinical presentation was similar in all three cases, with sudden-onset abdominal pain, an altered state of consciousness and hypotension. In all cases, investigation showed acute anaemia and large abdominal haematomas on imaging studies. A conservative approach was taken in the three patients, with suspension and reversal of anticoagulation, fluid resuscitation and red blood cell transfusion. Haemodynamic stability was achieved in two of the patients, but the third patient died.<br> The authors consider it is important to present these case reports because of the widespread use of enoxaparin, and the need for rigorous dose adjustment for renal function variations and body weight. We hope this article raises awareness of haemorrhagic complications in high-risk groups and propose protocols are introduced for dose adjustment and monitoring the efficacy of enoxaparin.</p> 2018-12-10T12:00:10+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/969 Mauriac Syndrome: A Rare Complication of Type 1 Diabetes Mellitus 2018-12-06T08:53:37+00:00 Maria João Rodrigues Ferreira Pinto mariajoao.rf.pinto@gmail.com Nuno Melo nunnomello@gmail.com Luís Flores luisqfs@gmail.com Francisco Cunha francisco.pcunha@gmail.com <p>Mauriac syndrome, first described in 1930, is typically diagnosed in young patients with poorly controlled type 1 diabetes mellitus and growth retardation, delayed puberty, Cushingoid features, hypercholesterolaemia and hepatomegaly. However, the sole presenting feature of Mauriac syndrome can be hepatic glycogenosis in both adults and children. The mainstay of treatment for hepatic glycogenosis is strict control of glucose levels, with an excellent prognosis with improved glycaemic control. The authors present the case of a 22-year-old female patient with type 1 diabetes mellitus and a history of poor glycaemic control who was admitted with diabetic ketoacidosis (DKA). She complained of episodes of right upper quadrant abdominal pain associated with nausea and vomiting for the last 2 months with worsening in the last 48 hours. Physical examination was remarkable for short stature and tenderness over the hepatic area with a mildly enlarged liver. The patient had elevated liver enzymes and persistent hyperlactacidaemia despite DKA resolution. Liver imaging suggested diffuse fat infiltration. The clinical suspicion of hepatic glycogenosis was confirmed by liver biopsy. After glycaemic control was improved, liver enzymes normalized and the episodes of abdominal pain, nausea and vomiting subsided.</p> 2018-12-06T08:49:04+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/986 Non-Uremic Calciphylaxis: A Rare Diagnosis with Limited Therapeutic Strategies 2018-12-04T10:30:54+00:00 Felisbela Miguel Gomes felisbelamiguelgomes@gmail.com Pedro La Feria felisbelamiguelgomes@gmail.com Catarina Costa felisbelamiguelgomes@gmail.com Rita Santos felisbelamiguelgomes@gmail.com <p>Calciphylaxis is a rare condition characterized by the emergence of non-healing skin ulcers secondary to arterial calcification and thrombosis, typically diagnosed in patients with end-stage kidney disease (ESKD). When it develops in patients without ESKD, it is called non-uremic calciphylaxis (NUC). The latter is an even rarer diagnosis with an uncertain pathophysiology and a high mortality rate (52%), mainly due to sepsis (50%). Cutaneous biopsy is diagnostic. Therapeutic measures recommended for NUC are limited to wound debridement, analgesia, and control of infection and risk factors. Other therapeutic options exist but with a low level of evidence. We present the case of a 78-year-old woman with NUC in her lower limbs who died of sepsis. NUC is a therapeutic challenge lacking efficient strategies.</p> 2018-12-04T10:13:31+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/987 Acute Non-Rheumatic Myopericarditis: A Rare Complication of Pharyngitis 2018-11-29T08:18:06+00:00 Rafael Silva rafaelduartepintosilva@gmail.com Luís Puga luis.romeu.puga@gmail.com Rogério Teixeira rogeriopteixeira@gmail.com Ana Botelho a.bota2@gmail.com Carolina Lourenço carolinanegrier@gmail.com Lino Gonçalves lgoncalv@ci.uc.pt <p>Acute non-rheumatic streptococcal myopericarditis (ANRSM) is a rare complication of an upper airway infection by streptococcus group A in developed countries. Cardiac involvement in bacterial infections must be adequately treated because it can lead to long-term complications. This case report describes recurrent ANRSM in an 18-year-old man, which illustrates how difficult and challenging the diagnosis of this disease can be.</p> 2018-11-29T08:14:07+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/982 Fatal Septic Shock Associated with Herpes Simplex Virus Hepatitis: A Case Report 2018-11-27T08:09:32+00:00 Valentine Inthasot valentine.inthasot@hotmail.com Adonis Goushchi amidonis@hotmail.com Silvia Lazzaroni lazzaroni.silvia@gmail.com Alberto Papaleo APAPALEO@his-izz.be Maria Gomez Galdon maria.gomezgaldon@bordet.be Didier Chochrad dchochrad@his-izz.be <p>Herpes simplex viruses are endemic worldwide, with an estimated seroprevalence of approximately 70% in developed countries. However, it is less well known that they are one of the viral causes of fulminant hepatitis (&lt;2%) and constitute &lt;1% of all causes of acute liver failure. We describe the case of an 89-year-old man who developed sepsis caused by a urinary tract infection due to drug-sensitive <em>Escherichia coli</em>. After empirical treatment with piperacillin-tazobactam was initiated, the patient’s condition worsened with shock, acute liver and renal failure, encephalopathy and persistent fever, that led to admission to the intensive care unit. The emergence of an acute abdomen prompted exploratory laparotomy but the patient died soon after surgery from abdominal haemorrhage. Immunohistochemical analysis of a liver biopsy specimen identified herpes simplex virus (HSV) hepatitis. The authors emphasize the need for better understanding of this rare condition in order to more precisely identify patients at risk who need more aggressive evaluation and empirical treatment, especially patients presenting with marked hepatic cytolysis with a rapidly worsening clinical evolution.</p> 2018-11-27T08:02:35+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/976 Remitting Seronegative Symmetrical Synovitis with Pitting Oedema as the First Manifestation of an Adenocarcinoma of the Caecum 2018-11-22T09:15:25+00:00 Edgar Pratas pratasmd@gmail.com João Carvalho jdsobrinhocarvalho@gmail.com Isabel Domingues isabel_domingues@hotmail.com João Fonseca medbudda@gmail.com Teresa Carvalho tmpct3@gmail.com Gabriela Sousa gsousa3140@gmail.com Manuel Teixeira Veríssimo mtverissimo@gmail.com <p>Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) is a rare syndrome that affects the elderly. Although the aetiology is not fully understood, it has been related to multiple diseases including cancer. We present the case of an 80-year-old man with a full spectrum of signs and symptoms compatible with RS3PE: sudden onset of bilateral polyarthralgia of the metacarpophalangeal and proximal interphalangeal joints, oedema of the dorsum of the hands, increased inflammatory markers and seronegative rheumatoid factor. After a 5-day course of corticotherapy, the patient became asymptomatic although maintaining a mild anaemia. During a search for the underlying cause of the RS3PE, an early stage adenocarcinoma of the caecum was diagnosed and surgically removed. No further treatment was performed and after 3 years of follow-up the patient remains without evidence of either paraneoplastic RS3PE or cancer.</p> 2018-11-22T08:51:51+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/977 Mycoplasma pneumoniae-associated Mucositis: A Recently Described Entity 2018-11-28T09:01:47+00:00 Inês Zão ineszao@gmail.com Fani Ribeiro fanisusana87@gmail.com Valter Rocha valter.rocha@gmail.com Pedro Neto pedrojoaosn29@gmail.com Carla Matias carlamatiassantos@gmail.com Gorete Jesus goretejesus2010@hotmail.com <p><em>Mycoplasma pneumoniae</em> (MP) is a common cause of respiratory infections and can be associated with extrapulmonary complications. MP mucositis has recently been described as a distinct endemic clinical entity called <em>Mycoplasma pneumoniae</em>-induced rash and mucositis (MIRM). The authors present the case of a 46-year-old man with atypical pneumonia associated with exuberant mucositis, conjunctival hyperaemia and positive serological assays for MP IgM. The patient was treated with azithromycin and systemic corticosteroid therapy. Supportive care including pain management, intravenous hydration and mucosal care was also given. There was complete resolution of the pneumonia and mucositis. The presence of atypical pneumonia with mucosal involvement without cutaneous lesions and a favourable clinical evolution led to the diagnosis of MIRM.</p> 2018-11-20T00:00:00+00:00 ##submission.copyrightStatement## https://ejcrim.com/index.php/EJCRIM/article/view/975 The Hippocratic Splash 2018-11-28T09:01:47+00:00 Geetha Girithari geets19@hotmail.com Inês Coelho dos Santos inescoelhodossantos@gmail.com Eva Claro ev_claro@hotmail.com Serguey Belykh sergoks@gmail.com David Matias davidcmathias@gmail.com Orlando Santos orlando65@sapo.pt <p>Although the current medical literature is limited, hydropneumothorax was described as far back as the 5th century BC. It is characterized by the presence of air and fluid in the pleural cavity and is an infrequent finding. Causes include trauma, iatrogenesis following thoracentesis, the presence of gas-forming organisms, tuberculosis and malignancy. Diagnosis is based on clinical and radiological features. We report a case of hydropneumothorax and present radiological images showing the distinctive features of this entity.</p> 2018-11-13T00:00:00+00:00 ##submission.copyrightStatement##