Revista Española de Casos Clínicos en Medicina Interna

Apalutamide and interstitial lung disease, an association to take into account

Wed, 24 Apr 2024 00:00:00 +0200

Interstitial lung disease (ILD) is a heterogeneous group of lung conditions whose etiology is varied, although toxins or other drugs can frequently cause it. Apalutamide is a selective inhibitor of androgen receptors used in cases of prostate cancer resistant to treatment with hormone blockade. There are three cases of drug-associated ILD published to date. We present a patient under treatment with apalutamide who developed a very rapid progression of ILD. An etiological diagnosis was made and treatment with high doses of corticosteroids was established, however, the patient died.

Abdominal pain in a patient with submandibular tumors

Wed, 24 Apr 2024 00:00:00 +0200

IgG4-related disease (ER-IgG4) is a chronic fibroinflammatory disorder of unknown etiology that affects multiple organs. The pancreas is affected in more than 50% of cases and the involvement of other organs together with the resolution of corticosteroid disease constitute distinctive features of this pathology. We present the case of a 53-year-old woman with abdominal pain, jaundice and submandibular tumors, elevated serum levels of IGG4, biopsy of the submandibular salivary glands compatible with fibrosis, images of the pancreas with enlargement and dilation of the bile ducts. These findings indicated towards a diagnosis of igG4 disease with systemic involvement.

Intracardiac fungoma as an atypical manifestation of disseminated coccidioidomycosis

Jesrrel Sharon, Beatriz, Jessica Jael — Wed, 24 Apr 2024 00:00:00 +0200

Coccidioidomycosis primarily affects lung tissue, occurring asymptomatically in up to 50% of cases. However, in up to 1% it can manifest with dissemination to other organs, with cardiac involvement being extremely rare. We describe the case of a patient diagnosed with meningeal coccidioidomycosis and spread to the cardiac cavities, manifesting as infective endocarditis due to the presence of a fungoma.

Not everything is peritoneal carcinomatosis. Differential diagnosis of peritoneal involvement.

Wed, 24 Apr 2024 00:00:00 +0200

Primary peritoneal carcinoma is a malignant epithelial tumor that affects practically only women, being histologically identical to epithelial ovarian carcinoma and fallopian tube carcinoma, as part of the spectrum of Mullerian tumors. Although it is still very rare, in the last decade, we are experiencing an increase in its incidence (0.68 per 100,000 population/years). We present a 59-year-old female patient, whose main symptoms included increase hardness of the abdominal cavity, constipation and ascites, diagnosed of primary peritoneal tumor.

Polyarthritis and cervical lesion of unexpected etiology

Wed, 24 Apr 2024 00:00:00 +0200

Polyarthritis is a common syndrome in our clinical practice with many possible underlying aetiologies. We analyze the case of a patient with polyarthritis with poor clinical and analytical evolution after starting corticosteroid treatment which raised the differential diagnosis, mainly between infectious and paraneoplastic aetiologies.

Management of refractory short bowel syndrome

Wed, 24 Apr 2024 00:00:00 +0200

Short bowel syndrome is a common malabsorption disease, secondary in most cases to surgical resection. We present the case of a 74-year-old man being followed up in the internal medicine day hospital for short bowel syndrome with the need for continuous administration of fluid therapy, hydroelectrolytes and parenteral nutrition. In order to improve the patient's quality of life, after several attempts to reduce parenteral support, medication with teduglutide was started in November 2019, achieving a progressive reduction of intravenous treatment until its complete withdrawal in May 2020.

Thrombotic microangiopathy in acute prostatitis

Wed, 24 Apr 2024 00:00:00 +0200

We present the case of a 46-year-old man who was admitted to the hospital for an episode of acute prostatitis and who, during hospitalization, presented a progressive and severe deterioration of renal function accompanied by hemolytic anemia and severe thrombocytopenia. After an etiological study, a diagnosis of thrombotic microangiopathy was reached. Treatment with eculizumab and plasmapheresis was started with a good response.

Cardiac angiosarcoma, a case report

Wed, 24 Apr 2024 00:00:00 +0200

Angiosarcoma is an extremely rare pathology with a male predominance. Echocardiography is the diagnostic mainstay. There is no defined therapeutic regimen and treatment is based on surgical resection accompanied by chemotherapy and radiotherapy, with a poor prognosis. Our clinical case deals with a young woman with cardiac angiosarcoma in the right atrium, as in 90% of cases, in which its debut as cardiac tamponade stands out, as well as the good initial response to the treatment regimen with chemotherapy and radiotherapy in neoadjuvant treatment, which achieved a survival of 12 months, higher than the average described.

Recurrent syncope due to paroxysmal atrial fibrillation as a presentation of apathetic hyperthyroidism

Joaquín Ferreira-Bacciarini — Wed, 24 Apr 2024 00:00:00 +0200

Apathetic hyperthyroidism is a rare form of hyperthyroidism, characterized by the absence of the classic symptoms of hypermetabolism generated by the increased synthesis of thyroid hormones. It affects mostly elderly people, and can manifest as cardiovascular disease, with cardiac arrhythmias. We report a case of apathetic hyperthyroidism secondary to toxic thyroid adenoma, which is presented with recurrent syncope in relation to paroxysmal atrial fibrillation.

Recurrent invasive liver abscess due to Klebsiella mucoviscidosa

Wed, 24 Apr 2024 00:00:00 +0200

Liver abscess is an infection with polymicrobial etiology, but the emergence of Klebsiella pneumoniae as the main cause, specifically serotypes K1 or K2 with a mucoid phenotype, is increasing in Europe. We present here the case of a 76 years old man who consulted due to fever. He had a history of two previous admissions for liver abscesses secondary to Klebsiella pneumoniae. The abdominopelvic CT showed a new liver abscess and the blood cultures were positive, again, for K. pneumoniae, confirming mucoviscid serotype K1.

Severe dermatomyositis: autoimmune diseases and their diagnostic delay

Wed, 24 Apr 2024 00:00:00 +0200

A 34-year-old woman with erythematous skin lesions, generalized edema, asthenia and proximal muscle weakness, was diagnosed after medical evaluation and complementary tests of dermatomyositis with positive anti-Mi-2 antibodies. The patient required treatment with pulses of methylprednisolone, rituximab and immunoglobulins due to severe involvement of the esophageal muscles and proximal extremities. During the 142 days of admission, the patient presented numerous complications with a slow response to the installed treatment. At 6 months had recovered swallowing, however, she continued to be dependent for basic activities of daily living due to proximal muscle weakness in the extremities.

The intangible qualities of the clinical cases publication

Carlos María San Román-Terán, María Dolores Martín-Escalante — Wed, 24 Apr 2024 00:00:00 +0200