European Journal of Case Reports in Internal Medicine <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> en-US <h3>Copyright and Disclosures</h3> <p>Every author must sign a copyright transfer agreement and disclose any financial or professional interest in any company, product, or service mentioned in an article. This authorization includes all submitted text including illustrations, tables, and other related materials.<br> If this submission contains any <strong>material that has been previously published</strong>, this authorization <strong>must also be accompanied</strong> by all necessary Permission to Reproduce Published Material" forms completed by the current copyright owner. If this submission contains any <strong>previously unpublished material</strong> for which the person(s) signing this form <strong>does not own copyright</strong>, an additional "Authorization to Publish" form is required from each corresponding copyright owner.</p> <h3>Copyright Transfer Declaration</h3> <p>(this may be included as a word document with your manuscript submission)<br> I confirm that I am the current copyright owner of the material described above and hereby transfer and assign to the European Journal of Case Reports in Internal Medicine (EJCRIM) all copyrights in and to the material for publication throughout the world, in all forms and media, in English and in any other language(s). Such transfer includes publication in this and all future editions of the publication named above and in any other publications (including slide collections and any other nonprint media) of EJCRIM and gives EJCRIM the sole authority to grant rights for use of the material by others.<br> I waive EJCRIM from any liabilities connected to the incorrect copyright statement.<br>The copyright agreement form can be downloaded <a style="font-weight: bold;" href="/documents/EJCRIM_Copyright_auth.pdf">HERE</a> or requested to the editorial office <a style="font-weight: bold;" href=""></a></p> (Editorial Office) (Editorial Office) Fri, 27 Sep 2019 15:48:43 +0000 OJS 60 Pituitary Apoplexy May Be Mistaken for Temporal Arteritis <p>Pituitary apoplexy is a rare endocrine emergency, characterized by a sudden increase in pituitary gland volume secondary to acute ischaemic infarction or haemorrhage of the pituitary gland, usually in the presence of a pituitary adenoma. We present the case of a 79-year-old man admitted for new-onset, bi-temporal and severe headache, associated with photophobia and vomiting, whose additional study revealed pituitary apoplexy. This case highlights the need for high clinical suspicion of this rare entity in order to reduce the associated mortality.</p> Bárbara Pedro, Tereza Patrícia, Fernando Aldomiro ##submission.copyrightStatement## Wed, 16 Oct 2019 07:16:09 +0000 Mandibular Osteonecrosis Associated with Antacid Therapy (Esomeprazole) <p><em>Introduction:</em> Osteonecrosis of the jaw has been consistently reported in the literature associated to the high-dose intravenous bisphosphonate therapy. However, osteonecrosis can also occur in patients who have other risk factors.<br> <em>Case description:</em> An unusual case of ONJ in a patient being treated with esomeprazole is reported.<br> <em>Discussion:</em> The probable association between proton pump inhibitor intake and osteonecrosis of the jaw should alert clinicians. Collaborations between medical and dental doctor and an early diagnosis might prevent or reduce the morbidity resulting from advanced destructive lesions of the jaw bone.</p> Simone Marconcini, Enrica Giammarinaro, Saverio Cosola, Anna Maria Genovesi, Ugo Covani ##submission.copyrightStatement## Mon, 14 Oct 2019 07:28:42 +0000 Focal Neurological Deficit Secondary to Severe Hyponatraemia Mimicking Stroke <p>Hyponatraemia is a common electrolyte abnormality seen by internists. Clinical features of hyponatraemia are primarily related to CNS dysfunction, and depend on the severity and acuity of changes in serum sodium concentration. Neurological manifestations of hyponatraemia range from nausea and malaise, with a mild reduction in the serum sodium, to lethargy, decreased level of consciousness, headache, seizures and coma in extreme cases. Focal neurological deficits are very rare in the setting of hyponatraemia. Here, we describe a patient with acute severe symptomatic hyponatraemia presenting with focal neurological deficits that resolved after correction of acute hyponatraemia.</p> Ahmad Nawid Latifi, Vanitha Gopal, Sina Raissi ##submission.copyrightStatement## Fri, 11 Oct 2019 07:06:36 +0000 Being Licked by a Dog Can Be Fatal: Capnocytophaga canimorsus Sepsis with Purpura Fulminans in an Immunocompetent Man <p>Bite infections caused by <em>Capnocytophaga canimorsus</em> are rare. Severe and fatal infections are more frequently reported in patients with immunodeficiency, splenectomy or alcohol abuse. We describe the case of a 63-year-old man who developed flu-like symptoms and presented after some delay with severe sepsis and purpura fulminans. He was found to be infected with <em>C. canimorsus</em> without a bite injury and did not demonstrate immunodeficiency or any other typical predisposition. Despite extensive intensive care, his conditions deteriorated and he died from multiorgan failure.</p> Naomi Mader, Fabian Lührs, Stefan Herget-Rosenthal, Martin Langenbeck ##submission.copyrightStatement## Wed, 09 Oct 2019 07:34:37 +0000 Severe FMF Presentation with Rare Association of MEFV Variants (p.Pro369Ser/p.Glu148Gln) <p>We report the case of a 28-year-old man who presented with recurring episodes of high fever, pleural and pericardial effusions and bilateral hydrocele. He was diagnosed with familial Mediterranean fever (FMF) and responded well to colchicine therapy. Genetic testing showed variants of the MEFV gene (p.Pro369Ser and p.Glu148Gln) previously independently described as having a more benign course of the disease. Their association is very rarely reported. Our patient and our review of the literature suggest that these genetic variants are associated with indolent courses but might also trigger the classic symptoms seen in severe FMF, probably in a compound heterozygous fashion. The combination of these variants should be taken into consideration in the diagnosis and management of patients.</p> Kenza El Alaoui, Alberto Papaleo ##submission.copyrightStatement## Mon, 07 Oct 2019 07:52:48 +0000 Abrupt Severe Chest Pain and Vomiting: Remember to Think of a Ruptured Oesophagus (Boerhaave Syndrome) <p>Boerhaave syndrome or spontaneous rupture of the oesophagus is a severe condition commonly misdiagnosed or unrecognized. Prognosis is poor even if the diagnosis is made promptly. We describe a case of Boerhaave syndrome diagnosed after the development of pneumomediastinum and cardiac arrest. Unfortunately, the patient died 48 hours after admission to the Intensive Care Unit. This entity requires a multidisciplinary management approach which may include conservative, surgical or endoscopic procedures.</p> Deeba Ali, Arnaud Detroz, Yilmaz Gorur, Lionel Bosquee, Benoît Cardos, Carla Cobanoiu, Noel Lorenzo Villalba ##submission.copyrightStatement## Fri, 04 Oct 2019 07:18:09 +0000 Immunoglobulin Treatment in Severe Ovarian Hyperstimulation Syndrome <p>A 32-year-old woman undergoing an in vitro fertilization program was admitted to our hospital with the diagnosis of severe ovarian hyperstimulation syndrome (OHSS). Transvaginal ultrasonography showed two gestational sacs. Treatment with fluid restriction, serum albumin and intravenous furosemide was started, and repeated thoracentesis and paracenteses were performed. In the absence of clinical improvement, the patient was transferred to the intensive care unit and a therapeutic abortion was suggested. Due to the similarities between OHSS and idiopathic systemic capillary leak syndrome, we offered the patient compassionate treatment with intravenous immunoglobulins. <br>After administration, the patient showed rapid improvement and we were able to suspend intravenous furosemide and serum albumin. She was discharged, and pregnancy has continued normally to date.</p> Gemma Grau, Oriol Giménez, Nuria Pons, Mireia Cairó, Pedro Almagro ##submission.copyrightStatement## Wed, 02 Oct 2019 07:15:44 +0000 Pneumothorax as a Presentation of Tuberous Sclerosis-Associated Lymphangioleiomyomatosis <p>Tuberous sclerosis complex (TSC) is a rare, autosomal dominant disorder with a recognized phenotypic variability with clinical manifestations developing continuously throughout life. The follow-up of TSC patients is challenging. The authors present a case with a definite diagnosis of TSC with known skin, renal, hepatic and neuropsychiatric involvement, whose diagnosis of TSC-associated lymphangioleiomyomatosis was establish at a late stage after the patient had presented with recurrent pneumothorax. Notwithstanding, mammalian target of rapamycin inhibition therapy was initiated.</p> Duarte Lages Silva, Pedro Pinto, Miguel Costa, Rosana Maia, Carmelia Rodrigues ##submission.copyrightStatement## Mon, 30 Sep 2019 08:08:43 +0000 Massive Spontaneous Haemothorax after Rivaroxaban Therapy for Acute Pulmonary Embolism <p>Spontaneous haemothorax complicating the treatment of pulmonary embolism is rare and potentially fatal. We describe a patient with pulmonary embolism and severe pleuritic pain who developed a life-threatening haemothorax 10 days later while on rivaroxaban therapy. This case highlights the fact that severe pleuritic pain associated with pulmonary embolism may indicate subclinical infarction of tissue near the visceral pleura with an increased risk of pleural effusion and the subsequent development of a haemothorax. It is important to recognise such danger signs warranting closer attention, especially since the increased use of direct oral anticoagulants has facilitated ambulatory care and this complication may manifest in the outpatient setting.</p> Yan Denise Tan, Kai Heng Raymond Goh, Heng Joo Ng ##submission.copyrightStatement## Fri, 27 Sep 2019 15:51:01 +0000 Invasive Pneumococcal Disease Associated with Fanconi-Like Syndrome <p>Acquired causes of Fanconi syndrome in adults are usually due to drugs, toxins or paraproteinaemias. Infectious causes are rarely described. We report a case of invasive pneumococcal disease in a patient who developed a Fanconi-like syndrome during the course of her illness. This patient presented with multiple electrolyte derangements consisting predominantly of hypokalaemia, hypomagnesaemia and hypophosphataemia during hospitalization for invasive pneumococcal disease with possible Austrian syndrome. Further evaluation revealed significant urinary losses of these electrolytes, uric acid and β2-microglobulin. Together with evidence of hypouricaemia, this is suggestive of proximal renal tubulopathy, and hence a Fanconi-like syndrome. The patient’s clinical condition and biochemical anomalies improved following pneumococcus treatment.</p> Jade Xiao Jue Soh, Raymond Kai Heng Goh, Shuwei Zheng ##submission.copyrightStatement## Fri, 27 Sep 2019 08:17:25 +0000