Category Archives: Case Report

Veno-venous ECMO for rapidly progressing interstitial lung disease: A multidisciplinary approach

Samreen Tariq, Fiona O’Hannigan, Nizrull Nasir, Serena O’Brien, Brian Marsh, Jennifer Hastings, John Stack, Josephine Kelliher, Katherine O’Reilly

Mater Misericordiae University Hospital, Dublin, Ireland

DOI: 10.2478/jccm-2026-0006

Introduction: This is a unique case of fulminant respiratory failure secondary to a rare cause of rapidly progressing ILD; antisynthetase syndrome (ASS). Failure to deliver timely multi-modal treatment in these cases can lead to increased morbidity and mortality.
Case presentation: A previously healthy 27-year-old male presented to his local hospital with a 1-week history of malaise, shortness of breath and cough. Initial work up including bloods and imaging were suggestive of community acquired multi lobar pneumonia, for which he received treatment as per local guidelines. Unfortunately, despite broad empirical antimicrobial cover, he continued to deteriorate with worsening type-1 respiratory failure requiring intubation and subsequent institution of prone position ventilation. Extensive microbiological investigations yielded no positive results. On day 7 of admission immunological testing revealed an ENA screen positive for Jo-1 antibody and a diagnosis of ASS was made. Despite treatment with immunosuppression the patient’s condition rapidly deteriorated and the decision to support with V-V ECMO was made following MDT consideration as there remained uncertainty as to the extent of reversibility of the underlying condition.
Conclusions: This patient recovered with combination of conventional immunosuppression, therapeutic plasma exchange and ECMO support. This case highlights Antisynthetase syndrome as a cause of reversible interstitial lung disease in the ICU and the importance of multi-disciplinary decision making and aggressive treatment approach in the management of such conditions.

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Transition from ICU to home care with long-term invasive ventilation using a single-limb BiPAP circuit

Mircea Stoian1, Nicolae Demenciuc2, Sergiu-Stefan Laszlo3, Anca Motataianu4, Dragoș-Florin Babă5, Adina Stoian6

1 Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2 Pneumology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
3 Mures County Hospital, Targu Mures, Romania
4 Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
5 Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
6 Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/jccm-2026-0004

Background: Patients with chronic respiratory failure caused by severe neuromuscular impairment often require long-term respiratory support. Invasive mechanical ventilation (IMV) via tracheostomy is usually provided in intensive care units (ICUs), but in carefully selected cases, it can be safely transitioned to home care. The use of a single-limb ventilator circuit (Single BiPAP circuit with Whisper Swivel II), intended initially for non-invasive ventilation (NIV), may represent a cost-effective and practical alternative for long-term home IMV.
Case presentation: We present a 50-year-old male with progressive neuromuscular disease and chronic respiratory failure, who required long-term IMV through a tracheostomy tube. After stabilization in the ICU, ventilation was maintained at home using a Single BiPAP circuit with Whisper Swivel II, combined with a mechanical insufflation-exsufflation (MIE) device for airway secretion clearance. The patient’s family received structured training in tracheostomy care, ventilator operation, and secretion management. Over 32-month period, the patient maintained stable respiratory function, experienced a marked reduction in infectious exacerbations, and preserved an acceptable quality of life.
Conclusion: In selected patients, long-term home IMV using a single-limb ventilator combined with an MIE device can be a safe, effective, and cost-efficient alternative to conventional ICU-based ventilation. Successful outcomes require structured patient and caregiver training, close follow-up, and coordinated multidisciplinary support.

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Warburg effect in B-cell lymphoma: A case report and proposed management plan

Stefan Gligor, Salim Abdelhamid, Veronika Ballova, Andrea Kopp Lugli

Baden Cantonal Hospital, Baden, Switzerland

DOI: 10.2478/jccm-2025-0045

Introduction: The Warburg effect is a rare but often fatal condition in patients with malignancies. This phenomenon, known as type B lactic acidosis, is defined by lactatemia without tissue hypoxia or hypoperfusion, in contrast to type A lactic acidosis, which usually results from either or both.
Case presentation: A male patient in his seventies with a newly diagnosed diffuse large B-cell lymphoma is admitted to the intensive care unit due to severe metabolic derangements with hypoglycemia and lactatemia. Extensive investigations ruled out alternative etiologies, strongly suggesting the Warburg effects as the underlying mechanism. Despite hemodynamic instability, chemotherapy was initiated and resulted in initial clinical improvement.
Conclusion: We propose a stepwise approach to improve the management of patients with suspected type B lactic acidosis.

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Severe acute respiratory syndrome coronavirus 2 infection and West Nile encephalitis in a patient with chronic kidney disease

Vince Akos Andrejkovits1, Alexandra Ioana Asztalos2, Nina Ioana Bodnar1, Erzsebet Iringo Zaharia-Kezdi1, Anca Meda Vasiesiu1

1 George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Romania
2 Mures County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/jccm-2025-0040

Objective: We describe a peculiar combination of West Nile virus (WNV) and SARS-CoV-2 infection, suggesting crucial clinical implications for diagnosis and management.
Case report: We present a case of a 57-year-old woman with a past medical history of end-stage renal disease (ESRD), on chronic hemodialysis, and arterial hypertension. She was admitted to the hospital for a 5-day history of fever, headache, vomiting, psychomotor slowing, a diffuse tremor on the four limbs, and diarrhea. Evaluation revealed the presence of neutrophilic leukocytosis, hemoglobin level of 10.5g/dL, elevated C-reactive protein (60 mg/L), serum creatinine of 13.4 mg/dL with hyperkaliemia. Neurologic examination described the following findings: neck stiffness, confusion with motor aphasia, bradylalia, bradypsychia, global hyperreflexia, diffuse tremor, and unstable gait. Brain CT described a calcified temporo-lateral meningioma, CSF examination revealed colorless appearing, 560 leucocytes/3microL (97% lymphocytes), 848 mg/L proteins, glycorrhachia: 54 mg/dL (serum glucose: 101 mg/dL), and the multiplex Real-Time PCR test result was negative. On the second day of admission, the patient tested positive for COVID-19 and she was commenced on therapy with remdesivir, ceftriaxone, dexamethasone, and clexane. Adequate hemodialysis sessions were performed. On the eighth day of admission, the diagnosis of WNV infection was made based on the positive serological findings and the presence of IgM antibodies in the cerebrospinal fluid. After 15 days of hospitalization, the patient was discharged in good clinical condition, except for mild tremor in her limbs.
Conclusions: Periodic epidemic bursts of WNV infection have been reported in Mures County, but present coinfection is rare; the severity and prognosis of the disease are unforeseeable.

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Severe acute respiratory distress syndrome in a woman infected with Ascaris lumbricoides

Alexandra Elena Lazar­, Mihai Claudiu Pui

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2025-0039

Acute Respiratory Distress Syndrome [ARDS] is a critical condition characterized by severe respiratory failure due to widespread lung inflammation, which can arise from various causes including trauma, infections, and systemic diseases. Among the rare causes is infection with Ascaris lumbricoides, a helminth typically affecting the gastrointestinal tract but capable of causing severe respiratory complications. We present the case of a 41-year-old woman with acute respiratory distress and negative viral and bacterial tests, who was ultimately diagnosed with Ascaris lumbricoides-induced ARDS. Her management included mechanical ventilation, antimicrobial therapy, corticosteroids, and eventually anthelmintic treatment after discovering the parasite. Despite initial deterioration and severe hypoxemia, the patient improved significantly following anthelmintic therapy, allowing extubation on day 8 and ICU discharge on day 12. Helminth-induced ARDS, though rare, should be considered in critically ill patients, especially in endemic regions. Early identification and appropriate therapy can dramatically improve outcomes.

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Right ventricular failure after LVAD support: A challenging case of bridge to heart transplantation in end-stage dilated cardiomyopathy

Horatiu Suciu1,2, Emanuel-David Anitei2, Paul Calburean3, Marius Mihai Harpa1,2

1 Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2 Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
3 Department of Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania

DOI: 10.2478/jccm-2025-0038

Introduction: End-stage heart failure due to dilated cardiomyopathy remains a major indication for advanced mechanical circulatory support and heart transplantation. Left ventricular assist devices have emerged as a vital bridge to transplant, improving survival and functional status. However, right ventricular failure following LVAD implantation is a significant and potentially fatal complication, requiring careful management to optimize outcomes.
Case presentation: We present the case of a 46-year-old male with post-myocarditis dilated cardiomyopathy, severely reduced left ventricular ejection fraction (21%), severe functional mitral and tricuspid regurgitation, and NYHA class IV heart failure. Despite optimal medical therapy, including inotropic support, the patient progressed to multiorgan dysfunction necessitating renal replacement therapy. A HeartMate 3 LVAD was implanted as a bridge to transplantation. The postoperative course was complicated by severe right ventricular failure, requiring prolonged inotropic support and careful hemodynamic management. Despite these challenges, the patient successfully underwent orthotopic heart transplantation. His postoperative evolution was favorable, with stable graft function and good clinical recovery documented during follow-up.
Conclusion: Right ventricular failure remains a major complication following LVAD implantation, significantly impacting outcomes. While LVADs have revolutionized the management of end-stage heart failure, heart transplantation continues to represent the definitive therapy offering superior long-term survival.

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Refractory metabolic acidosis and acute abdominal compartment syndrome following Holmium Laser Enucleation of Prostate (HoLEP)

Murugananth Nithiyananthan1, Shitalkumar Sharad Shah1, Aarthi Suhitharan2, Suhitharan Thangavelautham1

1 Singapore General Hospital, Singapore, Singapore
2 National Junior College, Singapore, Singapore

DOI: 10.2478/jccm-2025-0027

Introduction: Holmium Laser Enucleation of the Prostate (HoLEP) is a widely used minimally invasive surgical technique for benign prostatic hyperplasia (BPH), offering advantages such as reduced bleeding, shorter hospitalization, and elimination of TURP syndrome. However, complications related to fluid absorption and capsular perforation can still occur. We report a rare case of severe refractory metabolic acidosis and acute abdominal compartment syndrome (ACS) following HoLEP.
Case Presentation: A 74-year-old male with diabetes and hypertension underwent HoLEP for a 180-ml prostate, during which 106 liters of normal saline irrigation were used over three hours. Intraoperatively, the patient developed sudden respiratory distress and hypotension, with arterial blood gas analysis revealing severe metabolic acidosis (pH 7.141, HCO₃ 11 mEq/L, Cl 115 mEq/L), primarily due to excessive saline absorption and hyperchloremia. The patient required intubation, vasopressor support, and emergency dialysis due to worsening hemodynamic instability. Postoperative imaging revealed intra-abdominal fluid collection, which was drained percutaneously. After two days of intensive ICU management, the acidosis resolved, and the patient was successfully extubated.
Conclusion: This is the first case highlighting the potential risks of normal saline absorption and the effect of capsular perforation, which caused ACS and refractory acidosis, and required CRRT due to the prolonged duration of HoLEP.

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Transient systolic anterior motion in a patient with junctional rhythm in the intensive care unit

Alfred Ibrahimi1, Saimir Kuci1, Ormir Shurdha2, Romina Teliti3

1 Division of Intensive Care, Mother Teresa Hospital, Tirana, Albania
2 Division of Cardiology, Mother Teresa Hospital, Tirana, Albania
3 Division of Cardiology, German Hospital International, Tirana, Albania

DOI: 10.2478/jccm-2025-0021

Systolic anterior motion (SAM) of the mitral valve refers to the unusual movement of the anterior and sometimes the posterior mitral valve leaflets toward the left ventricular outflow tract (LVOT) during systole. This phenomenon is most frequently associated with the asymmetric septal variant of hypertrophic cardiomyopathy (HCM), but it can also occur in conditions like acute myocardial infarction, diabetes mellitus, hypertensive heart disease, after mitral valve repair, and even in asymptomatic individuals during dobutamine stress tests. We present a case of transient SAM induced by a junctional rhythm along with high doses of dobutamine and nitroglycerin in an intensive care unit (ICU) setting. Transesophageal echocardiography (TEE) played a crucial role in detecting SAM and showed that transitioning from a junctional rhythm to a ventricular paced rhythm led to an improvement in the SAM condition.

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The use of intraventricular vancomycin in subacute brain abscess in an adolescent male: A case report

Tomas Leng1, Ibrahim Serhat Karakus2

1 Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
2 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA

DOI: 10.2478/jccm-2024-0046

Introduction: Brain abscess is a serious condition in children, leading to rapid deterioration, and permanent neurological damage associated with significant morbidity and mortality. Current management protocols for brain abscesses focus on intravenous antibiotics and surgical excision and drainage.
Case Presentation: A 12-year-old adolescent male who had headache and photophobia and was diagnosed with multiple brain abscesses and was refractory to conventional medical and neurosurgical intervention. A single dose of 10 mg vancomycin was administered through endo-ventricular drain , resulting in resolution of abscesses and alleviation of symptoms.
Conclusion: We describe the first instance of intraventricular vancomycin use in the pediatric age group for the treatment of multiple brain abscesses. Given the variability in dosing reported in the literature, our case report warrants further studies to standardize dosage for this rare intervention.

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Acute Calculous Cholecystitis Associated with Leptospirosis: Which is the Emergency? A Case Report and Literature Review

Renata Moriczi, Mircea Gabriel Muresan, Radu Neagoe, Daniela Sala, Arpad Torok, Tivadar jr. Bara, Ioan Alexandru Balmos, Razvan Ion, Anca Meda Vasiesiu

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/jccm-2024-0033

Introduction: Leptospirosis is a bacterium with a worldwide distribution and belongs to the group of zoonoses that can affect both humans and animals. Most cases of leptospirosis present as a mild, anicteric infection. However, a small percentage of cases develop Weil’s disease, characterized by bleeding and elevated levels of bilirubin and liver enzymes. It can also cause inflammation of the gallbladder. Acute acalculous cholecystitis has been described as a manifestation of leptospirosis in a small percentage of cases; however, no association between leptospirosis and acute acalculous cholecystitis has been found in the literature.
Case presentation: In this report, we describe the case of a 66-year-old patient who presented to the emergency department with a clinical picture dominated by fever, an altered general condition, abdominal pain in the right hypochondrium, nausea, and repeated vomiting. Acute calculous cholecystitis was diagnosed based on clinical, laboratory, and imaging findings. During preoperative preparation, the patient exhibited signs of liver and renal failure with severe coagulation disorders. Obstructive jaundice was excluded after performing an abdominal ultrasound and computed tomography scan. The suspicion of leptospirosis was then raised, and appropriate treatment for the infection was initiated. The acute cholecystitis symptoms went into remission, and the patient had a favorable outcome. Surgery was postponed until the infection was treated entirely, and a re-evaluation of the patient’s condition was conducted six-week later.
Conclusions: The icterohemorrhagic form of leptospirosis, Weil’s disease, can mimic acute cholecystitis, including the form with gallstones. Therefore, to ensure an accurate diagnosis, leptospirosis should be suspected if the patient has risk factors. However, the order of treatments is not strictly established and will depend on the clinical picture and the patient’s prognosis.

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