SPMI Case Reports

Black Esophagus: A Case of Upper Gastrointestinal Bleeding in a Diabetic Patient

Inês Parreira — 2025-08-01

Iatrogenic Pneumothorax After Nasopulmonary Intubation: A Nasogastric Intubation Complication

Rita Soares Costa — 2025-08-01

Effusion or Mass?

Sara Isabel Vasconcelos — 2025-08-01

Caseous Calcification: An Unexpected Echographic Finding

Carolina António Santos — 2025-08-01

Orbital Metastasis of Breast Cancer

Adriana Henriques — 2025-08-01

More than a Case: The Enduring Value of Clinical Case Reports in Medical Education

Dominique Valla — 2025-08-01

Paroxysmal Nocturnal Hemoglobinuria: An Unusual Suspect

Mariana Rita Mesquita Silva Estrela Santos — 2025-08-01

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare and underdiagnosed acquired hematopoietic stem cell disease, which can be revealed by intravascular hemolysis, thrombosis and secondary bone marrow failure. A delay on diagnosis could be due to a multiplicity of symptoms and clinical presentations, requiring a high clinical suspicion. The authors describe a case of PNH with a variety of clinical presentations, typical and atypical, leading to diagnosis. The increasing awareness of these presentations makes possible a future quickly identification and diagnosis of this rare condition.

Cotrimoxazole Induced Toxic Epidermal Necrolysis: A Clinical Case

Carolina Veiga — 2025-08-01

We present the case of a 53-year-old man, with no relevant personal medical history who was on the seventeenth day of treatment with cotrimoxazole after a diagnosis of a urinary tract infection.

He was admitted to the emergency department complaining of a pruritic maculopapular rash that was widespread, with particular emphasis on the torso and sparing the palms of the hands and soles of the feet, bilateral conjunctival hyperemia, lip edema, and odynophagia.

After an extensive study was conducted, the conclusion was that it was a side effect of the ongoing treatment, and the antibiotic was promptly suspended. However, the skin and mucosal lesions progressed unfavorably, with an increase in the affected area and an important involvement of the oral and ocular mucosa with extensive erosions. The diagnosis of toxic epidermal necrosis was made, a rare entity that occurs as a side effect of commonly prescribed antibiotics and other drugs.

Gallstone Ileus Presenting as Suspected Bouveret Syndrome: A Diagnostic and Therapeutic Challenge

Alexandra Cristina Silva Wahnon — 2025-08-01

Biliary ileus is a rare cause of intestinal obstruction, resulting from the migration of a gallstone through a bilioenteric fistula, with subsequent impaction in the gastrointestinal tract. Bouveret syndrome is a rare subtype of biliary ileus that occurs due to the impaction of a gallstone in the pyloric canal or the duodenum. Despite its low incidence, this clinical condition is associated with a significant mortality rate, which can reach up to 15%. Thus, early diagnosis, based on a high index of clinical suspicion and timely treatment are essential.

The authors present a clinical case of probable Bouveret syndrome, highlighting the associated diagnostic and therapeutic challenges, given that no specific treatment has been established. This diagnosis should be considered in cases of proximal intestinal obstruction, despite its rarity.

Nephrotic Syndrome as an Initial Manifestation of Secondary Syphilis: A Clinical Case

Carolina Roias — 2025-08-01

Syphilis is a systemic disease with highly varied clinical presentations, caused by the spirochete Treponema pallidum. In the secondary stage of the disease, renal involvement can occur, with a prevalence ranging from 0.3% to 0.8%, and it can present in various forms. The association between secondary syphilis and nephrotic syndrome has been documented for several years and may even be the only manifestation of the infectious disease. In the presence of de novo nephrotic-range proteinuria in a patient with known risk factors, syphilis screening should be considered. The following clinical description reports a case of secondary syphilis with renal involvement, presenting initially as nephrotic syndrome.

Reversible Visual and Neurological Manifestations of Nonketotic Hyperglycemia: A Case Report

Carolina Abreu — 2025-08-01

Nonketotic hyperglycemia (NKH) has been associated with visual field and neurological alterations, typically reversible with glycemic control.

A 54-year-old woman with hypertension and dyslipidemia presented in the emergency department with a 2-week history of headaches, left visual field photopsia and polydipsia and polyuria. Examination revealed homonymous left hemianopia, along with brief episodes of head and eye deviation to the left, consistent with focal epileptic seizures originating in the right hemisphere, later confirmed by electroencephalogram. Ophthalmologic exams ruled out ocular alterations, while lab results showed hyperglycemia with normal pH, excluding infections and autoimmune causes. Magnetic resonance imaging (MRI) revealed right occipital lobe changes consistent with a postictal state. With glycemic normalization and antiepileptic treatment, her visual symptoms and seizures resolved. After two months, she remained asymptomatic, and her MRI was normal.

This case demonstrates that NKH can cause reversible visual and neurological symptoms, including specific MRI findings, underscoring the importance of recognizing these manifestations for timely diagnosis and treatment.