European Journal of Case Reports in Internal Medicine <p>The <strong>European Journal of Case Reports in Internal Medicine</strong> is an official journal of the European Federation of Internal Medicine (EFIM). The journal wants to promote the practice of internal medicine in Europe. Its aim is to provide a forum to internal medicine doctors.<br> <strong>EJCRIM</strong> welcomes papers describing unusual or complex cases and case series that an internist may encounter in everyday practice. Case series are also welcomed as long as they demonstrate the appropiateness of a therapeutical approach or unusual manifestation of a disease.<br> The journal would also consider brief reasoned reports of issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to scientific meetings of European societies of Internal Medicine.<br> <strong>EJCRIM</strong> utilizes the CNR-SOLAR system to permanently archive the journal for purposes of preservation, reservation and research and it is also indexed on Google Schola, DOAJ and HINARI. We encourage the use of Kudos to maximize the article's visibility.<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previously unpublished material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) Wed, 31 Jan 2018 09:02:37 +0000 OJS 60 Inverted Variant of Takotsubo Syndrome Caused by Inhaled Adrenergic Beta-2 Agonists <p>Takotsubo syndrome (TS) is an acute and reversible clinical syndrome characterized by transient hypokinesis of the left ventricular (LV) apex. Variant forms of LV dysfunction have been reported, including inverted Takotsubo syndrome (ITS), which represents only 5% of cases and has previously been linked to excessive use of inhaled adrenergic beta-2 agonists. The authors describe the case of a 60-year-old female patient who was diagnosed with ITS after the excessive use of inhaled adrenergic beta-2 agonists. This case highlights an uncommon variant of this syndrome that may not be obvious and must be suspected in this particular context.</p> Marta de Sousa, André Casado, Alexandre Buinhas Marques, Francisco Pereira Machado, Isabel Esperança ##submission.copyrightStatement## Tue, 20 Feb 2018 08:21:24 +0000 An Unusual Case of Tricuspid Stenosis <p>Tricuspid stenosis is an uncommon valvular abnormality commonly associated with other valvular lesions. Ebstein's anomaly is a rare congenital heart malformation characterized primarily by abnormalities of the tricuspid valve and right ventricle. Endomyocardial fibrosis is a restrictive cardiomyopathy observed in tropical and subtropical regions. It may cause right ventricular distortion with apparent apical displacement of the tricuspid valve, mimicking Ebstein’s anomaly. Eosinophilia is the most commonly cited aetiological link in endomyocardial fibrosis. Here we report the case of 42-year-old male patient who presented with heart failure and severe tricuspid stenosis where a diagnosis of hypereosinophilic syndrome was also established. This case represented a diagnostic challenge in the search for the definitive cause of the tricuspid stenosis.</p> Sara Ferreira, Arsénio Barbosa, Filipa Gomes, Jorge Almeida, Jorge Santos Almeida, Mário Amorim, José Paulo Araújo ##submission.copyrightStatement## Fri, 16 Feb 2018 08:07:59 +0000 Mesenteric Panniculitis in Sjögren’s Syndrome: A New Systemic Manifestation to Consider? <p>The association between mesenteric panniculitis and Sjögren's syndrome, although rare, is starting to be recognized. Usually, mesenteric panniculitis is symptomatic, presenting with either general or gastrointestinal symptoms. Sjögren's syndrome is an autoimmune disease that typically affects secretory glands, but may have serious systemic involvement. We report the case of a 77-year-old patient in whom accidental discovery of asymptomatic mesenteric panniculitis on computed tomography led to the diagnosis of Sjögren's syndrome with several systemic manifestations.</p> Patrícia Afonso Mendes, Diana Marques Ferreira, Helena Temido, Rui Pina, Armando Carvalho ##submission.copyrightStatement## Wed, 14 Feb 2018 08:04:04 +0000 Electrolyte Disorders as Triggers for Takotsubo Cardiomyopathy <p>A 56-year-old woman presented with cognitive impairment, confusion and slowed speech, muscle cramps and peripheral paraesthesia preceded by vomiting. Blood tests revealed severe hypokalaemia, hyponatremia, hypomagnesemia and hypocalcaemia. Following a diagnosis of Takotsubo cardiomyopathy based on ultrasonography, the patient was treated with electrolyte supplementation and recovered within 48h. When heart failure is suspected, electrolyte abnormalities should be carefully ruled out as they can affect cardiac function.</p> Fabio Andreozzi, Giovanni Cominetti, Rafik Karmali, Prochore Kamgang ##submission.copyrightStatement## Mon, 12 Feb 2018 09:15:17 +0000 Deep Vein Thrombosis of the Left Leg: A Case of May-Thurner Syndrome <p>A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization. <br> CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May–Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization.</p> Jiten Desai, Zalak Desai, Jay Shah, Ofek Hai, Andrea Mignatti, Roman Zeltser, Amgad Makaryus ##submission.copyrightStatement## Thu, 08 Feb 2018 12:42:16 +0000 Hyperglycaemic Hemichorea <p><em>Background:</em> Hyperkinetic disorders such as hemichorea can be caused by cerebrovascular, infectious or inflammatory diseases or by metabolic conditions such as hyperglycaemia. Hyperglycaemic hemichorea is a rare movement disorder which is frequently misdiagnosed. It is characterized by involuntary, continuous, non-patterned movements on one side of the body, basal ganglia lesions seen on head CT or MRI, and clinical improvement after blood glucose normalization. We describe the case of a female patient with uncontrolled diabetes who presented with hemichorea. <br> <em>Case presentation:</em> We report the case of a 69-year-old woman with type 2 diabetes who presented with abnormal movements of the right upper limb. She had no neurological signs other than hemichorea. Her blood glucose level was 349 mg/dl and her glycosylated haemoglobin level (HbA1c) was 10.5%. Head CT and MRI showed no changes in the basal ganglia or ischaemic lesions. The patient was started on insulin and haloperidol with clinical improvement.<br> <em>Conclusion:</em> Larger case series are needed to establish better understanding of the physiopathological mechanisms and diagnostic criteria of hyperglycaemic hemichorea. The most important diagnostic criterion is clinical improvement after glycaemic control.</p> Joana Silva Marques, Nuno Monteiro, Ana Nunes, João Machado, João Olivério, Ana Sofia Martins, Antonio Correia ##submission.copyrightStatement## Tue, 06 Feb 2018 08:06:38 +0000 Atraumatic Splenic Rupture after Myocardial Infarction <p>Atraumatic splenic rupture is a rare but potentially life-threatening event. It mostly happens when the spleen is already diseased; however, sometimes it can be drug induced in a previously normal spleen. Although anticoagulation has been attributed to spontaneous splenic rupture quite frequently, the role of dual antiplatelet therapy is underestimated. We report a case of an 80-year-old woman who developed spontaneous splenic rupture 4 weeks after starting dual antiplatelet therapy.</p> Muhammad Fahad Arshad, Nasir Javed, Syed Monawer Karim, Ehtasham Ahmad, Noor Ul Ain Abid ##submission.copyrightStatement## Thu, 01 Feb 2018 09:35:05 +0000 Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone <p><em>Objectives:</em> To report a case of mechanical aortic prosthesis <em>Brucella</em> endocarditis successfully treated with antibiotics alone.<br> <em>Materials and methods:</em> We describe a clinical case and present a review of the literature.<br> <em>Results:</em> A 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve <em>Brucella</em> mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve <em>Brucella</em> endocarditis without surgery have been reported.<br> <em>Conclusion:</em> Prosthetic valve <em>Brucella</em> endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone.</p> José Pedro Fonseca, Telma Pereiro, Diana Pinho dos Santos, José Miguel Correia, Joana Capelo, Adelino Carragoso ##submission.copyrightStatement## Tue, 30 Jan 2018 11:54:55 +0000 Klebsiella pneumoniae Invasive Syndrome <p><em>Klebsiella pneumoniae</em> invasive syndrome (KPIS) is a rare clinical condition characterized by primary liver abscess associated with metastatic infection. Most case reports are from Southeast Asia, with only one case described in Portugal. The Authors present the case of a 44-year-old man with a history of fever, dry cough and cervicalgia. A thoracic computed tomography (CT) scan showed multiple pulmonary and hepatic nodules, suggestive of metastatic malignancy. Both blood cultures and bronchoalveolar lavage were positive for <em>Klebsiella pneumoniae</em>. Imaging studies were repeated during his hospital stay, showing a reduction in both number and volume of identified lesions, thus revealing their infectious nature. This case illustrates how much this entity can mimic other illnesses.</p> Vasco Evangelista, Cristiana V. Gonçalves, Raquel Almeida, Célia Henriques, António Martins Baptista, José Pimenta da Graça, José Lomelino Araújo ##submission.copyrightStatement## Fri, 26 Jan 2018 08:43:01 +0000 Low Back Pain: A Pain That May Not Be Harmless <p>Abdominal aortic aneurysms are defined as vascular dilatations greater than 50% of the normal proximal segment or those that have a maximum diameter above 3 cm. Risk factors include male gender, age over 75 years, history of vascular pathology, hypertension and arteriosclerosis. The Authors describe a case of a 74-year-old man, evaluated in an emergency setting for right lumbar pain lasting 4 days. The pain did not respond to analgesia and became progressively worse. Due to the severity of symptoms, CT angiography was performed, which showed an active rupture of a partially contained aneurysm associated with aortic dissection. Early diagnosis and timely management of aortic aneurysms are essential in preventing complications, namely rupture (50-83% patients die after rupture and before receiving medical care). Acute aortic dissection is a surgical emergency and the risk of rupture is proportional to the size of the aneurysm and its rate of growth.</p> Ana Catarina Lucas, Joana Costa, Joana Paixão, Pedro Ribeiro, Fatima Silva, Adriano Rodrigues ##submission.copyrightStatement## Wed, 24 Jan 2018 11:45:17 +0000