European Journal of Case Reports in Internal Medicine

An effective treatment for multiple sclerosis urinary disorders through a formulation of Delta-9-tetrahydrocannabinol and cannabidiol: a case report

2020-11-29T10:16:50+00:00

Spasticity represents an important cause of disability for patients with multiple sclerosis. Even more, dysfunction of the bladder greatly aggravates the patient’s burden and is responsible for their poor quality of life. Here, I report a case of a 35-year-old woman suffering from relapsing remitting multiple sclerosis, with a slight spastic para-paresis associated to an important urinary urge incontinence. The first-line antispastic treatments, physiotherapy and symptomatic drugs for urinary disorders did not bring any benefit. Instead, nabiximols relieved the woman's urinary symptoms, improving her sleep and quality of life without side effects.

Strongyloides stercolaris infection in a male patient with unusual gastrointestinal tract manifestation and lower limb deep venous thrombosis: A case report

2020-11-28T20:05:52+00:00

ABSTRACT

We report a case of strongyloidiasis in a 48-year-old male who presented with gastrointestinal symptoms and developed acute cholecystitis and deep venous thrombosis. Strongyloidiasis is uncommon in Saudi Arabia but must be considered for patients with gastrointestinal symptoms who recently arrived from an endemic area or will begin immunosuppressive therapy.

Pyogenic ventriculitis associated with urosepsis – a rare case report

2020-11-28T10:27:15+00:00

Pyogenic ventriculitis is an infection of the cerebral ventricles usually associated with neurosurgery or head trauma. There are less than ten reported cases of community-acquired pyogenic ventriculitis in adults. We present the case of a 71-year-old man with a medical history of type 2 diabetes mellitus, hospitalized due to urosepsis caused by E.coli. Because he had a fluctuant level of consciousness, he underwent magnetic resonance imaging that diagnosed pyogenic ventriculitis. He was treated with ceftriaxone 2g 12/12h for a total of 6 weeks and recovered without neurological deficits. Pyogenic ventriculitis is a clinical challenge for its rarity, atypical presentation and variety of etiological microorganisms.

CNS Demyelination under anti-TNF Medication; Coincidence or causal?

2020-11-27T15:45:16+00:00

We describe the case of a 40-year-old patient with active Crohn’s disease (CD)-who developed neurological symptoms and was subsequently diagnosed with cerebral demyelination shortly after re-exposure to a therapy with Adalimumab. Based on the current state of scientific knowledge, we here discuss whether concurrent diagnosis of demyelinating disease and the anti-tumor-necrosis-factor (TNF)-alpha-therapy develop independently or whether direct causality is more likely. Basis for this purpose are the diseases´ incidence rates and the different pathophysiological hypotheses for demyelination under anti-TNF-alpha-therapy. Due to high incidence of cerebral demyelination and lack of laboratory or clinical markers to differentiate the underlying influences, a definite conclusion cannot be drawn. Based on the here presented findings and state of the literature, we finally deduce recommendations for clinical practice and research gaps.

An unusual infection: a case report of Staphylococcus capitis infective endocarditis complicated with spondylodiscitis.

2020-11-26T16:46:52+00:00

Introduction: Spondylodiscitis, consisting of the inflammation of vertebral bodies and/or intervertebral disk, is ?an infrequent, but potentially serious, infection. In relation to infective endocarditis, and while ?rheumatological complications are described, spondylodiscitis is rare, and seems to be associated with ?systemic embolization, mostly in patients with mitral valve involvement. ?

Case description: A patient presented with history of general deterioration and unexplained, persistent fever, later complicated with severe lumbar pain. Upon admission, following the algorithm for fever with unknown origin, the diagnosis of Staphilococcus capitis infective endocarditis complicated with spondylodiscitis was reached.

Discussion: Spondylodiscitis is an infrequent complication of native-valve endocarditis, and Staphilococcus capitis, mainly a commensal, is a rare agent in both infections in the absence of surgery or prosthetic infection, highlighting the importance of also considering usual commensals in potentially serious infections.

Granulomatosis with polyangiitis overlapping with IgG4-related disease?

2020-11-26T10:51:39+00:00

IgG4-related disease (IgG4-RD) and granulomatosis with polyangiitis (GPA) share several clinical manifestations as well as the presence of ANCA antibodies and serum IgG4 immunoglobulins. Because of the imbricating clinical similarities, it is often difficult to distinguish the 2 entities delaying diagnosis and hence adequate treatment. There are very few compelling lines of evidence underlying the potential overlap between the two diseases. We hereby report the case of a 60-year-old patient portraying the clinical conundrum with clinical and biological features of GPA and IgG4-RD.

Poland syndrome. A case that proves again to clinicians that every child must be completely undressed in physical examination

2020-11-26T09:43:49+00:00

Poland Syndrome is an association of multiple congenital anomalies in a patient’s body. Most patients have absence or underdevelopment of pectoralis major muscle associated by possible athelia, hypoplasia of the breast, agenesis of cartilages and syndactyly. It is a rare syndrome, so to diagnose it every doctor can examine carefully and undress his/her patient. Herein, the presentation of a Poland Syndrome case proves the importance of undressing the patient to avoid misdiagnosis.

Miliary tuberculosis: remarkable cerebrospinal fluid

2020-11-25T08:12:01+00:00

Tuberculosis remains one of the common infectious diseases. Miliary tuberculosis is a rare and possibly lethal form, due to lymphohematogenous dissemination of Mycobacterium tuberculosis. The authors describe the case of an 83 year-old previously healthy woman, diagnosed with miliary tuberculosis with both pulmonary tuberculosis and tuberculosis meningitis. Her remarkable yellow cerebrospinal fluid (CSF) and high CSF protein (> 100 mg/dl) were different parameters between the tuberculous meningitis and control. Because prognosis largely depends on timely treatment, prompt diagnosis is important. Thus, treatment should be initiated as soon as the diagnosis is suspected.

Immune thrombocytopenia in Helicobacter pylori infection and Sjögren’s syndrome with low complement component 4

2020-11-24T08:49:01+00:00

Immune thrombocytopenia is an acquired thrombocytopenia caused by antiplatelet autoantibodies. Immune thrombocytopenia may occur in association with underlying diseases such as infection, malignancy, and autoimmune disease. However, most cases are classified as idiopathic immune thrombocytopenia and lack an identifiable cause. We herein described a case of immune thrombocytopenia in a patient with Helicobacter pylori infection and Sjögren’s syndrome with low complement component 4. Physicians should consider Sjögren’s syndrome as an underlying disease of Immune thrombocytopenia, particularly in patients with low complement levels and/or non-responders to H. pylori eradication therapy.

Pulmonary Synovial Sarcoma - an unpleasant surprise

2020-11-22T18:26:11+00:00

The authors describe a case of a patient with primary monophasic pulmonary synovial sarcoma presenting as a right pleural effusion and all the underlying diagnostic challenges.