Internal Medicine

Community-acquired pneumonia (CAP) is a serious public health concern and a major cause of mortality and morbidity. Despite advances in antimicrobial therapies, microbiological diagnostic tests and prevention measures, pneumonia remains the main cause of death from infectious disease in the world. An important reason for the increased global mortality is the impact of pneumonia on chronic diseases, along with the increasing age of the population and the virulence factors of the causative microorganism.
In 2013, the Global Burden of Disease Study based on data from 188 countries around the world, reported that lower respiratory tract infection was the second most common cause of death. In Europe, mortality rates for CAP vary widely from country to country, ranging from <1% to 48%.

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Autoimmune hepatitis is chronic hepatitis associated with hypergammaglobulinaemia and the presence of circulating autoantibodies. In most cases it responds favorably to immunosuppressive therapy. Diagnosis is challenging, in general, all other possible causes of chronic hepatitis should be excluded. The case report describes a case of type 1 autoimmune hepatitis in a 69-year-old patient.

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Duchenne muscular dystrophy (DMD) is a hereditary progressive neuromuscular disorder that is inherited in X-linked recessive pattern. Mutation of dystrophin gene results into a loss of integrity and function of muscular fibres and their replacement by adipose and connective tissue. Muscle degeneration leads to motoric impairment and loss of walk around 12th year of age. Myocardium is also frequently affected. Respiratory muscles impairment and other complications lead to respiratory failure. If left untreated, death occurs around 20th year of life, usually due to cardiac or respiratory causes. Respiratory insufficiency development is treated by mechanical ventilation support.

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Systemic lupus erythematosus (SLE) is an autoimmune disease, mostly with a chronic course, that can affect almost all important organs, most commonly skin, joints, heart and vessels, kidneys, central nervous system and lungs. The disease is characterized by B-lymphocyte hyperactivity, which leads to the formation of autoantibodies predominantly directed against non-specific antigens. This case study describes a case of SLE with multiple organ complications in a 29-year-old female patient.

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Myocarditis is an acute inflammatory condition that can have an infectious, toxic or autoimmune aetiology. Myocarditis can complicate many infections in which inflammation may be due directly to infection of the myocardium or the effects of circulating toxins. The clinical picture ranges from a symptomless disorder, sometimes recognised by the presence of an inappropriate tachycardia or abnormal ECG, to fulminant heart failure. Myocarditis may be heralded by an influenza-like illness. In most patients, the disease is self-limiting and the immediate prognosis is excellent. However, death may occur due to a ventricular arrhythmia or rapidly progressive heart failure. Myocarditis has been reported as a cause of sudden and unexpected death in young athletes. Some forms of myocarditis may lead to chronic low-grade myocarditis or dilated cardiomyopathy. The case report describes a case of parainfectious myocarditis in a 20-year-old patient.

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Obstructive sleep apnoea (OSA) is characterized by repetitive episodes of interruption of breathing during sleep due to partial or complete collapse of pharynx. Prevalence of mild OSA is about 9-24%, clinically significant disease is present in about 4% men and 2% women. Morphology of upper airways and body weight are important factors for development of OSA. Approximately 70% of OSA patients are overweight and 40% obese patients suffer from OSA.

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Kyphoscoliosis is a well-recognized cause of respiratory failure. Kyphoscoliosis is a chronic disease, occurring in 2-3% of the general population, which leads to a distorted spinal curvature and chest wall deformity. As a consequence, respiratory function is impaired due to reduced chest wall compliance and restrictive lung function pattern arises. The development of noninvasive ventilation (NIV) has made it an accepted standard modality of care at the present time for patients with chronic respiratory failure caused by kyphoscoliosis. The presented case report describes a 49-year-old female with idiopathic kyphoscoliosis who developed chronic hypercapnic respiratory failure with the need of noninvasive ventilatory support.

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Presented case report documents an example of a patient with an accidentally diagnosed chronic obstructive pulmonary disease (COPD) based on clinical signs. Diagnosis was confirmed by a pneumologist using spirometry. A bronchodilation test was carried out to confirm the irreversibility of detected obstructive ventilatory impairment. The patient was given combined bronchodilator treatment with ß2-mimetics and anticholinergics to relieve symptoms, improve functional parameters and prevent subsequent exacerbations.

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Lung abscesses are caused due to microbial infection when an area of infected lung becomes necrotic, which results in the development of a cavity containing pus or necrotic debris within the lung itself (Figure 1). In contrast to pleural infection, the incidence and mortality rate of lung abscesses have steadily declined since antibiotic era. The case report presents a 43-year-old patient with multiple lung abscesses.

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Isolated posterior myocardial infarction is occurring in 3-11% of all infarctions. ST - segment depression in leads V1-V3 suggests myocardial ischaemia, especially when the terminal T - wave is positive (ST - segment elevation equivalent), and confirmation by concomitant ST-segment elevation ≥ 0,5mm recorded in leads V7-V9 should be considered as a mean to identify posterior myocardial infarction. Emergent coronary angiography and percutaneous coronary intervention of the infarct - related artery is indicated.

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