European Journal of Case Reports in Internal Medicine 2021-06-24T21:55:17+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> Thymoma and Tuberculoma: unexpected coexistence 2021-06-24T21:55:17+00:00 Antonio Grilo Novais Diana Pinho Santos Mariana Conceição Sara Cunha Joana Capelo Pedro Crespo Lina Carvalho <p><em>Mediastinal tumours can be incidental findings at chest X-Ray or present with systemic symptoms and/or direct effect of the mediastinal mass. We report a case of a woman with symptomatic thymoma B1 and simultaneous thymus tuberculosis</em>.</p> Copyright (c) Primary biliary cholangitis: a case of underdiagnosis 2021-06-24T18:18:09+00:00 Sofia Garcês Soares Sofia Rodrigues Carvalho Marina Mendes Diana Pereira Anjos Ana João Sá Mari Mesquita <p>Primary biliary cholangitis is a rare autoimmune cholestatic disease with a variable clinical course. Its etiopathogenesis has not been completely clarified. It predominantly affects women and it often progresses to liver cirrhosis.</p> <p>It may be asymptomatic or symptomatic with hepatic or extrahepatic manifestations.</p> <p>We describe the clinical case of a 63-year-old woman, with no history of hepatotoxic drugs, who presented an analytical pattern of cytocholestasis with more than 1 decade of evolution.</p> <p>If its diagnosis and treatment are made early, the progression to cirrhosis and liver failure can be prevented.</p> Copyright (c) Gorham Stout’s Disease With Clinical Response to Sirolimus Treatment 2021-06-24T06:17:03+00:00 Santiago Forero Saldarriaga Camilo Vallejo Lizeth Urrea Pineda Anderson Osma Carlos Bonilla Gonzalez <p>Gorham-Stout disease (GSD) is a rare clinical entity of unknown etiology, with osseous resorption, vascular structures proliferation, and inflammation of adjacent soft tissues. Clinical spectrum varies from asymptomatic patients to patients with pain, functional limitation, or deformity. GSD may affect one or multiple bones in any location; however, predilection for maxillofacial area and upper limbs has been described. We present a case report of a 33-year-old male patient with facial pain and loss of dental pieces; imaging showed extensive lytic involvement of the mandible and cranial bones; after exclusion of malignant, metabolic, infectious, or autoimmune disease, a diagnosis of GSD was made. Treatment with sirolimus was prescribed, achieving a symptomatic improvement and stability of imaging findings. It is remarked on the importance of the knowledge of this orphan disease, to achieve a prompt diagnosis and medical treatment.</p> Copyright (c) Posterior reversible encephalopathy syndrome revealing Takayasu’s arteritis in a child 2021-06-23T18:19:40+00:00 Abdelhamid Jadib Yassine Harmoumi Lamiaa Chahidi El Ouazzani Othmane Soussi Siham Salam Dalal Laoudiyi Kamilia Chbani Lahcen Ouzidane <p>Posterior Reversible Encephalopathy Syndrome (PRES) is a rare complication of Takayasu's Arteritis (TA). We report the case of an 11-year-old girl who presented with a tonic-clonic seizure and loss of consciousness, without fever. Imaging revealed characteristic white matter edema of the occipital and parietal lobes, in keeping with PRES.&nbsp; Further imaging demonstrated right renal artery stenosis and wall thinking of the abdominal aorta. The combination of hypertension, the discrepancy of blood pressure recordings between upper limbs, and imaging abnormalities of the aorta and the left renal artery led to the diagnosis of PRES secondary to TA. Treatment with oral corticosteroids, azathioprine, amlodipine, and propranolol resulted in the complete resolution of the patient's symptoms and imaging abnormalities.</p> Copyright (c) Management of Wolff-Parkinson-White Syndrome in a Patient with Post-Partum Cardiomyopathy 2021-06-23T15:27:37+00:00 Snigdha Bendaram Sherif Elkattawy Muhammad Atif Masood Noori Hardik Fichadiya Sarah Ayad Parminder Kaur Raja Pullatt Fayez Shamoon <p>Wolf-Parkinson-White (WPW) syndrome is a congenital heart condition in which the atrioventricular (AV) node is bypassed by an accessory pathway that connects the atria and ventricle directly. WPW syndrome in patients with a history of peripartum cardiomyopathy (pregnancy-related cardiomyopathy) is associated with a high risk of morbidity and mortality secondary to failure of the pump and the conduction system of the heart. Management of these cases deals with arrhythmia and systolic heart failure, which becomes more challenging in pregnant patients as it requires treatment methods that minimize risks to the fetus. We report a case of a young female patient with WPW syndrome and postpartum cardiomyopathy presenting with symptomatic arrhythmias (tachycardia).</p> Copyright (c) Thymoma-associated pure red cell aplasia following femoral neck fracture 2021-06-23T13:36:41+00:00 Morika Suzuki Takashi Watari <p>Pure red cell aplasia (PRCA) is a rare haematopoietic disease that presents with severe anaemia and a marked decrease in the numbers of reticulocytes and bone marrow erythroblasts. Thymomas are the most common underlying cause of chronic PRCA and have been implicated in the development of other autoimmune diseases, such as myasthenia gravis. However, the pathogenesis and mechanisms underlying the development of thymoma-associated PRCA remain unclear.</p> <p>Herein, we present a case of thymoma associated PRCA, which was diagnosed in a patient who developed progressive anaemia after a femoral neck fracture. The absence of severe pre- and postoperative anaemia, and the rapid progression of anaemia over a 2-month period suggested that the fracture and subsequent surgery may have triggered thymoma-associated PRCA. The patient was treated with cyclosporine and primobolan, but remained dependent on red blood cell transfusion, as noted at follow-up.</p> Copyright (c) Hypoplastic Coronary Artery Disease Presenting with Ventricular Fibrillation Cardiac Arrest 2021-06-22T00:34:30+00:00 Abra Guo Hooman Bakhshi James O'Hara Leonard Genovese Adam Fein Alireza Maghsoudi Chirag Sandesara <p>Hypoplastic coronary artery disease is a rare congenital anomaly that may present with ischemic heart disease, heart failure, or sudden cardiac death (SCD). We describe a case of cardiac arrest in a healthy young male. Work-up revealed hypoplastic left anterior descending artery. The patient underwent cardioverter-defibrillator implantation for secondary prevention.</p> Copyright (c) Kaposi’s Sarcoma after corticosteroid therapy in a Non-HIV patient with Chronic Eosinophilic Pneumonia 2021-06-19T12:40:22+00:00 Cristina Pires Correia Juliana Ribeiro Gonçalves Manuela Dias Sofia Pereira Paulo Chaves Leonor Escaleira Jorge Almeida <p>&nbsp;</p> <p>Kaposi's Sarcoma (KS) is classified into 4 variants: classical, endemic, Acquired Immunodeficiency Syndrome related and associated with immunosuppressive therapy. It has been sporadically described in patients with corticosteroid therapy (CT) for haematological, rheumatological, and pulmonary diseases. Chronic Eosinophilic Pneumonia (CEP) is a rare interstitial lung disease that often requires long-term corticosteroid therapy. We report the case of an 83-year-old black woman with insidious dyspnea and cough, associated with bronchoalveolar eosinophilia and radiological finds of bilateral peripheral ground-glass opacities of both lungs. She was diagnosed with CEP and maintained prednisolone (20-25mg) for 18 months, not tolerating lower doses. She noticed the appearance of violaceus nodules in the upper limbs, which corresponded to KS after pathological examination. The relevance of excluding other reasons of pulmonary eosinophilia, as well as investigating other causes of immunosuppression is discussed. In this case, KS might be associated not only with CT, but also with the immune dysregulation underlying immunoallergic and autoimmune diseases and, in particular, eosinophilic ones. This case highlights the therapeutic dilemma underlying long-term use of corticosteroid therapy, with iatrogenic KS being a potentially serious side effect. We discuss the need to find a balance between immunosuppression and potential tumor progression, with alternative treatments.</p> Copyright (c) A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient with COVID-19 2021-06-18T18:06:25+00:00 Latika Patel Sarah Ayad Mohammad Nabil Rayad Kirolos Gergis Chidinma Ejikeme Afrah Talpur Ari Eckman <p>Diabetic ketoacidosis (DKA) is a significant complication of poorly controlled diabetes. In diabetics, it typically occurs due to insulin deficiency resulting in lipolysis and subsequent ketone body formation and acidosis.&nbsp; The emergence of the COVID-19 infection has been associated with several complications, with the most prominent being pulmonary and cardiovascular-related. However, in some cases, patients with COVID-19 infection present with diabetic ketoacidosis.&nbsp; The pathophysiology of DKA in COVID-19 infection is different and currently not completely understood. The manifestation of DKA in COVID-19 patients is associated with increased severity of mortality and length of stay in these patients.&nbsp; Here, we describe a patient with no past medical history who presented with COVID-19 symptoms and was found to be in DKA. This case report highlights the possible underlying pathophysiology associated with this complication.</p> Copyright (c) Lithium Toxicity Presenting as Myxedema Crisis and Nephrogenic Diabetes Insipidus 2021-06-18T13:29:58+00:00 Tatiana Pires Catarina Duarte Santos Miguel Gonzalez Santos Luís Luz Ana Ferrão Maria J. Banza <p>Lithium carbonate has long been used as a mood stabilizer in the management of several psychiatric illnesses, mainly bipolar disorder. It has a narrow clinical index and there are three recognized types of toxicity – acute, chronic and acute-on-chronic.</p> <p>Lithium toxicity may be associated with a wide variety of clinical presentations. Thyroid toxicity is frequent but severe hypothyroidism with myxedema crisis due to chronic lithium toxicity is a rare occurrence. Nephrogenic Diabetes Insipidus is also associated with chronic lithium use.</p> <p>Here we present a case of chronic lithium toxicity manifesting as myxedema crisis and nephrogenic diabetes insipidus.</p> Copyright (c)