European Journal of Case Reports in Internal Medicine
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 40 national societies from 38 European countries . 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. EJCRIM…
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Latest posts
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Extreme bradycardia in BRASH syndrome unmasked by severe amiodarone-induced hypothyroidism
Introduction: BRASH syndrome – bradycardia, renal failure, AV nodal blockade, shock and hyperkalaemia – is a self-amplifying pathophysiological loop. Its association with severe amiodarone-induced hypothyroidism is rarely described in detail. Case description: A 79-year-old…
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Pulmonary sclerosing pneumocytoma may be an under-recognized pulmonary manifestation of the phosphatase and tensin homolog deleted on chromosome 10 (PTEN) hamartoma tumour syndrome
Introduction: Pulmonary sclerosing pneumocytoma (PSP) is a rare, benign neoplasm driven by somatic AKT1 mutations that activate the PI3K/AKT/mTOR pathway. Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) hamartoma tumour syndrome (PHTS) results from germline…
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Sudden bilateral blindness revealing MPO-ANCA-associated hypertrophic pachymeningitis in an 82-year-old woman
Introduction: Hypertrophic pachymeningitis is a rare inflammatory thickening of the dura mater, complicating an estimated 1–3% of ANCA-associated vasculitis (AAV), usually PR3-ANCA disease with systemic involvement. Isolated meningeal disease with normal inflammatory markers is…
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Triple-positive antiphospholipid syndrome with splenic infarction triggered by tocilizumab withdrawal in a high-titer ACPA-positive rheumatoid arthritis patient: an unmasking storm of polyautoimmunity
Introduction: We describe the occurrence of an uncommon thrombotic event, namely splenic infarction, as the onset of antiphospholipid syndrome (APS) after temporary suspension of anti-IL-6 treatment in a patient with rheumatoid arthritis (RA). Case description: A 53-year-old…
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Tropheryma whipplei infection mimicking sarcoidosis with an atypical course: a molecularly confirmed diagnosis without PAS-positive intestinal disease
Introduction: The bacterium Tropheryma whipplei causes Whipple’s disease, a rare chronic infection that can involve virtually any organ, especially in the late phase, and mimic inflammatory or neoplastic conditions. The interval from first symptoms to diagnosis is typically…
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Recurrent catamenial hemopneumothorax caused by diaphragmatic endometriosis not identified by chest X-ray or CT scan: a case report and literature review
Introduction: Thoracic endometriosis syndrome (TES) is a rare extrapelvic manifestation of endometriosis. Catamenial hemopneumothorax secondary to diaphragmatic endometriosis is particularly uncommon and remains a diagnostic challenge because of its nonspecific clinical and…
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Probable HHV-6 limbic encephalitis after liver transplantation: diagnostic overlap with tacrolimus neurotoxicity and refractory status epilepticus
Human herpesvirus 6 (HHV-6) encephalitis is an uncommon but severe post-transplant complication. A 64-year-old woman developed confusion, behavioural changes, and staring episodes 6 months after liver transplantation. Cerebrospinal fluid (CSF) multiplex testing was positive for…
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Beware of tall stature: growth hormone excess associated with a rare parasellar extra-axial tumour—diagnostic and management challenges in a resource-limited setting
Introduction: Tall stature can be the sole indicator of growth hormone (GH) excess, which causes pituitary gigantism before epiphyseal fusion. In developing regions like Indonesia, a lack of systematic screening often delays diagnosis. While classic presentations involve…
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Ectopic ACTH syndrome presenting as refractory hypokalemia in metastatic castration-resistant prostate cancer with neuroendocrine transformation
Ectopic adrenocorticotropic hormone (ACTH) syndrome resulting from neuroendocrine transformation of prostate adenocarcinoma may present with refractory hypokalemia as an initial manifestation. Because hypokalemia is often attributed to other more common aetiologies, the…
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Tolosa-Hunt syndrome as a presentation of Sjögren’s-associated vasculitis
Tolosa-Hunt syndrome is a clinical quadrad consisting of unilateral headache, ipsilateral cranial nerve palsy, granulomatous inflammation on imaging or biopsy and no other headache syndrome to explain the diagnosis. It may be secondary to systemic inflammatory disease, and…
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Granulomatous hepatitis due to Bartonella henselae mimicking stage IV malignancy
Introduction: Hepatosplenic cat-scratch disease (HS-CSD) is a rare manifestation of Bartonella henselae infection in immunocompetent adults and may closely mimic haematological malignancy. Case description: A 62-year-old woman with a history of breast cancer presented with an…
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Combined calcium channel blocker and angiotensin-converting enzyme inhibitor overdose
Introduction: Combined overdoses of angiotensin-converting enzyme inhibitors and calcium channel blockers are rare but associated with more severe toxicity than either agent alone. Case description: A 48-year-old woman presented to the emergency department nine hours after…
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Shrinking lung syndrome with favourable response to belimumab and corticosteroids alone
Introduction: Shrinking lung syndrome (SLS) is a rare complication of systemic lupus erythematosus. It is characterized by dyspnoea and a restrictive ventilatory defect, often associated with pleuritic chest pain. Given its rarity, there is no standardized treatment. Most…
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Scleroedema preceding monoclonal gammopathy by 30 years
Three decades after the diagnosis of scleroedema (Buschke’s disease), a benign chronic sclerotic skin condition of unknown pathogenesis without systemic involvement, a patient developed secondary gout and normocytic anaemia. Investigations revealed monoclonal gammopathy of…
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Endoscopic drainage of an intra-abdominal chylous collection
Introduction: Chylous leak is an increasingly recognised complication following pancreatic surgery. It results from the disruption of the lymphatic system and may lead to persistent chylous ascites or collection. Ongoing chyle loss is associated with significant morbidity…
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Against all odds: repeated successful pregnancies in two women with unrepaired single-ventricle physiology
Introduction: Pregnancy in women with unrepaired single-ventricle physiology is rare and associated with substantial maternal and foetal risk. Evidence regarding pregnancy outcomes in this population remains limited. Case description: We report three successful pregnancies in…
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Ulcerative pancreatic panniculitis complicated by secondary infection and delayed wound healing in a patient undergoing haemodialysis
Introduction: Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease. Case description: A 75-year-old man on maintenance haemodialysis with a history of IgG4-related autoimmune pancreatitis presented with painful subcutaneous nodules on the lower…
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Pyoderma gangrenosum and haematochezia in a patient with previous cocaine abuse
Introduction: Pyoderma gangrenosum (PG) is an autoinflammatory neutrophilic dermatosis that may rarely occur in association with granulomatosis with polyangiitis (GPA). Management of refractory disease remains challenging. Case description: A 48-year-old man with a history of…
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Iatrogenic hypercalcemia in a patient with type 2 diabetes and chronic kidney disease
Introduction: The introduction of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and non-steroidal mineralocorticoid receptor antagonists (nsMRA) has significantly improved outcomes in patients with type 2 diabetes, obesity and chronic kidney disease (CKD). However, the…
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Refractory vasoplegic septic shock after gallbladder perforation: a case report and focused review of oXiris-enhanced CRRT
Introduction: Persistent vasoplegia after source control and guideline-based care remains a major challenge in septic shock. In patients with acute kidney injury requiring continuous renal replacement therapy (CRRT), oXiris combines renal support with endotoxin and cytokine…