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"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."

"After a remarkable decade as Editor-in-Chief, Dr. Kellett has laid the foundation of our journal with an Editorial piece that embodies our vision — a true manifesto of EJCRIM mission! This article clarifies the journal's aims and scope, providing a solid tool for both editors and authors."

"Introduction: Paradoxical reactions during anti-tuberculosis treatment are immune-mediated reactions that complicate treatment even in immunocompetent patients.Case description: We present the case of a previously healthy 24-year-old man with disseminated tuberculosis, who experienced persistent fever, weight loss, and radiological deterioration despite appropriate treatment. These findings were consistent with a paradoxical reaction to treatment, after extensive work-up excluded treatment failure, co-infections, and systemic inflammatory conditions. However, high-dose corticosteroids failed to achieve improvement. Ultimately, an interleukin-1 receptor antagonist (anakinra) was initiated as a salvage therapy for this corticosteroid-refractory paradoxical reaction, resulting in rapid defervescence, normalization of inflammatory markers, and radiological improvement.Conclusion: This case underscores the diagnostic and therapeutic challenges when managing severe reactions in tuberculosis patients, while highlighting the importance of biologics like anakinra in corticosteroid-refractory paradoxical reactions."

"Introduction: Mediastinal osteosarcoma is an exceptionally rare and aggressive malignancy arising in a location devoid of osseous structures. Unlike conventional osteosarcoma, which originates in the metaphyseal regions of long bones in younger individuals, mediastinal osteosarcoma develops within soft tissue, leading to a poorly understood pathogenesis and unpredictable clinical behaviour. Owing to its nonspecific symptoms and imaging overlap with other mediastinal tumours, early diagnosis is challenging. To date, around ten well-documented cases have been reported.Case description: A 41-year-old man presented with progressive dyspnoea of 3 months’ duration. Laboratory tests were unremarkable except for elevated alkaline phosphatase. Computed tomography revealed a 10 × 8.8 cm calcified anterior mediastinal mass with multiple calcified pulmonary nodules and lymphadenopathy. Robotic bronchoscopy of a minimally calcified right middle lobe nodule revealed a high-grade sarcomatoid malignancy forming malignant osteoid. Tumour cells expressed SATB2 (Special AT-rich sequence-binding protein 2) and were negative for epithelial markers (Pancytokeratin, TTF-1, Napsin A, and P40). The findings favoured a diagnosis of extraskeletal osteosarcoma. Positron emission tomography/computed tomography scan demonstrated distant metastases to the brain and the absence of any primary bone lesions. The case was discussed in a multidisciplinary tumour board, and combined chemotherapy with Cisplatin and Doxorubicin was initiated, along with radiotherapy targeting the intracranial lesion, followed by Regorafenib, a kinase inhibitor.Conclusion: Mediastinal osteosarcoma should be considered in the differential diagnosis of calcified mediastinal masses. Accurate diagnosis depends on adequate tissue sampling and immunohistochemical profiling. Continued reporting of such rare cases is essential to improve understanding of clinical behaviour and optimize therapeutic strategies for these tumours."

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Case reports in the past, present and future