Korean Journal of Family Medicine

A case report of semaglutide induced sarcopenia: causes of fatigue in older adults: Azwan Aziz Mohamad; Received January 9, 2025 Accepted February 6, 2025 Published online April 14, 2025; DOI: https://doi.org/10.4082/kjfm.25.0008 [Epub ahead of print]

Semaglutide, a medication used for type 2 diabetes and weight loss, may have unexpected side effects such as sarcopenia and age-related loss of muscle mass and strength. A 74-year-old male patient with type 2 diabetes and dyslipidemia presented with progressive fatigue over 2 years. He experienced a significant decline in walking endurance and speed despite the absence of joint pain or other obvious causes. He had a history of ocular myasthenia gravis and localized prostate cancer, both of which were well-managed. Further investigation revealed a weight loss of 8 kg after starting semaglutide treatment for diabetes. Physical examinations revealed reduced muscle bulk and strength. Extensive investigations, including blood tests, imaging, and cardiopulmonary exercise testing, have ruled out other potential causes of fatigue. The patient’s fatigue improved after reducing the semaglutide dose and implementing a tailored exercise program that focused on muscle strengthening. This case highlights the potential contribution of semaglutide to muscle mass loss and subsequent fatigue, particularly among older adults.

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Chiari malformation type I with extensive syringomyelia presenting as progressive bilateral foot drop: a case report: Siti Anisah Jamaludin, Suraya Abdul-Razak, Shalini Bhaskar, Mimi Nashra, Nik Munirah Nik Mohd Nasir, Nordini Asri; Received January 23, 2025 Accepted February 23, 2025 Published online April 11, 2025; DOI: https://doi.org/10.4082/kjfm.25.0020 [Epub ahead of print]

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Chiari malformation type I (CMI) is a structural abnormality characterized by cerebellar tonsil herniation through the foramen magnum, often leading to disrupted cerebrospinal fluid dynamics and syringomyelia. While CMI commonly presents with occipital headaches and neck pain, atypical manifestations, such as bilateral foot drops, are exceedingly rare. We describe a 37-year-old female patient presenting with bilateral foot drop, which was later established to be caused by syringomyelia secondary to CMI. Magnetic resonance imaging revealed an 8 mm tonsillar descent and a syrinx extending to the conus medullaris. The patient refused surgical intervention and opted for conservative management; partial functional recovery was subsequently observed. This report emphasizes the importance of recognizing rare neurological presentations of CMI. To our knowledge, this is the first documented case of CMI with syringomyelia presenting as a bilateral foot drop.

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Quetiapine-induced hypokalemic periodic paralysis in a pregnant woman: a case report: Muhammad Hafiz Mohamed Pauzi, Azidah Abdul Kadir, Syaheedatul Iman Dinsuhaimi, Zainab Mat Yudin, Wan Nazirah Wan Yusuf; Korean J Fam Med 2025;46(2):115-119. Published online March 19, 2025; DOI: https://doi.org/10.4082/kjfm.24.0301

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Quetiapine-induced hypokalemic periodic paralysis (QIHPP) is a rare condition. Herein, we present the case of a 31-year-old pregnant Malay woman diagnosed with bipolar II disorder and QIHPP. She presented to the casualty department with a 2-day history of bilateral lower limb weakness and numbness. Her renal function tests showed moderate hypokalemia (2.5 mmol/L), whereas other investigations were normal. Quetiapine was suspected to be the cause, prompting a psychiatric referral to manage her acute condition. Balancing the risks of untreated QIHPP against the potential relapse of bipolar symptoms from quetiapine discontinuation or dosage reduction poses a significant treatment challenge for pregnant women with QIHPP. Finally, we reduced the quetiapine dosage after careful consideration, leading to the normalization of potassium levels and symptom resolution. Therefore, clinicians should be aware of this side effect when initiating or continuing quetiapine treatment in women of childbearing age or pregnant women with psychiatric disorders. It is crucial to monitor serum electrolytes, especially potassium, following quetiapine administration and warn patients about its potential side effects.

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Fasting is not always good: perioperative fasting leads to pronounced ketone body production in patients treated with SGLT2 inhibitors: a case report: Jae Chan Choi, Yo Nam Jang, Jong Hoon Lee, Sang Wook Park, Jeong A Park, Hye Sook Kim, Jae Won Choi, Joo Hyung Lee, Yong Jae Lee; Received August 28, 2024 Accepted November 14, 2024 Published online March 7, 2025; DOI: https://doi.org/10.4082/kjfm.24.0210 [Epub ahead of print]

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Ketone bodies produced by sodium-glucose cotransporter 2 (SGLT2) inhibitors can be advantageous, providing an efficient and stable energy source for the brain and muscles. However, in patients with diabetes, ketogenesis induced by SGLT2 inhibitors may be harmful, potentially resulting in severe diabetic ketoacidosis (DKA). During fasting, ketone body production serves as an alternative and efficient energy source for the brain by utilizing stored fat, promoting mental clarity, and reducing dependence on glucose. The concurrent use of SGLT2 inhibitors during perioperative fasting may further elevate the risk of euglycemic DKA. We describe a case of DKA that occurred during perioperative fasting in a patient receiving empagliflozin, an SGLT2 inhibitor. This case underscores the importance of recognizing the potential risk of DKA in patients with diabetes using SGLT2 inhibitors during perioperative fasting.

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Hemicrania continua with rhinosinusitis: a case report: Dae Hyun Kim, Yoonseo Lee; Korean J Fam Med 2025;46(1):48-51. Published online January 20, 2025; DOI: https://doi.org/10.4082/kjfm.24.0178

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Hemicrania continua (HC) is an indomethacin-responsive headache, characterized by unilateral and continuous headaches with cranial autonomic symptoms. Various pathologies, including sinus-related conditions, are associated with HC. Here, we report the case of a 62-year-old man with HC and rhinosinusitis. The patient complained of a unilateral continuous headache with ipsilateral cranial autonomic symptoms, conjunctival injection, and eyelid edema for 20 months. HC was identified as a potential diagnosis based on the symptom criteria, and a response to indomethacin confirmed the diagnosis. Trigeminal autonomic cephalalgia should be considered in patients with unilateral headaches and cranial autonomic symptoms.

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A Rare Presentation of Probable Training-Related Chronic Myopericarditis in an Endurance Cyclist: A Case Report: Azwan Aziz Mohamad, Nahar Azmi Mohamed; Korean J Fam Med 2024;45(2):116-120. Published online February 14, 2024; DOI: https://doi.org/10.4082/kjfm.23.0082

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We report a rare case of high-volume training-related myopericarditis. A male, 18 years old, elite road bicycle racing cyclist with high-volume training of 1,000 km per week for >7 years, presented with progressively worsening exertional breathlessness, reduced effort tolerance, and one episode of cardiac syncope. The symptoms were present prior to the coronavirus disease 2019 pandemic but made worse with the sudden increase in the volume of training after lockdown periods in preparation for competition. He exhibited multiple premature ventricular ectopic beats during his resting electrocardiogram, with a normal echocardiogram and non-elevated cardiac enzyme. The exercise stress test revealed similar multiple premature ventricular beats, warranting further investigation using cardiac magnetic resonance imaging (MRI). The findings of the cardiac MRI were suggestive of myopericarditis. He was instructed to refrain from training and initially started with a short course of colchicine. However, his symptoms deteriorated, and cardiac MRI revealed a decrease in the left ventricular ejection fraction from 59% to 50%. His treatment was escalated to a short course of tapered dose steroid, anti-failure medication and gradual, supervised, return to sports program. This case report highlights the discussion of return to play in athletes with myopericarditis.

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A Case Report of Rare Adverse Events Associated with Venlafaxine Administration: Hypoglycemia and Lactic Acidosis: Serdar Özdemir; Korean J Fam Med 2022;43(1):83-85. Published online November 22, 2021; DOI: https://doi.org/10.4082/kjfm.20.0100

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We report the first case of hypoglycemia and lactic acidosis caused by the therapeutic doses of venlafaxine. A 19-year-old female patient had presyncope and she was taking venlafaxine 75 mg once a day because of major depression for a week and she had no history of any other drug use or disease. The blood gas analysis revealed hypoglycemia and lactic acidosis. Patient was treated with dextrose infusion and oral diet. Although hypoglycemia and lactic acidosis have been reported in overdose of venlafaxine in the literature, these effects were observed in therapeutic doses.

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Nils Mein, Khadija Mammadli, Felix Luessi, Timo Uphaus
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A Diagnosis to Consider in an Adult Patient with Facial Features and Intellectual Disability: Williams Syndrome: Özlem Akgün Doğan, Pelin Özlem Şimşek Kiper, Gülen Eda Utine, Mehmet Alikaşifoğlu, Koray Boduroğlu; Korean J Fam Med 2017;38(2):102-105. Published online March 22, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.2.102

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Williams syndrome (OMIM #194050) is a rare, well-recognized, multisystemic genetic condition affecting approximately 1/7,500 individuals. There are no marked regional differences in the incidence of Williams syndrome. The syndrome is caused by a hemizygous deletion of approximately 28 genes, including ELN on chromosome 7q11.2. Prenatal-onset growth retardation, distinct facial appearance, cardiovascular abnormalities, and unique hypersocial behavior are among the most common clinical features. Here, we report the case of a patient referred to us with distinct facial features and intellectual disability, who was diagnosed with Williams syndrome at the age of 37 years. Our aim is to increase awareness regarding the diagnostic features and complications of this recognizable syndrome among adult health care providers. Williams syndrome is usually diagnosed during infancy or childhood, but in the absence of classical findings, such as cardiovascular anomalies, hypercalcemia, and cognitive impairment, the diagnosis could be delayed. Due to the multisystemic and progressive nature of the syndrome, accurate diagnosis is critical for appropriate care and screening for the associated morbidities that may affect the patient's health and well-being.

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Williams–Beuren syndrome: a complete guide for oral healthcare
Pavan Manohar Patil, Seema Pavan Patil
Journal of Oral Medicine and Oral Surgery.2021; 27(2): 21. CrossRef

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Escitalopram-Induced Amenorrhea and False Positive Urine Pregnancy Test: Vithyalakshmi Selvaraj, Siv Hour, Palanikumar Gunasekar, Caron Gray, James F. Smith; Korean J Fam Med 2017;38(1):40-42. Published online January 18, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.1.40

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Escitalopram is a selective serotonin reuptake inhibitor antidepressant approved by the Food and Drug Administration for the treatment of major depressive disorder and generalized anxiety disorder. A 34-year-old female patient with major depressive disorder developed amenorrhea and had a false-positive urine pregnancy test after initiation of escitalopram treatment. To our knowledge, no published case report of amenorrhea and false-positive urine pregnancy tests in women taking escitalopram exists. This case report suggests that women of child-bearing age should be carefully monitored for amenorrhea while they are on an antidepressant treatment regimen.

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False-positive urine pregnancy screening tests are uncommon in the hospital setting among patients with bowel-containing urinary tract reconstruction
Alyssia Venna, Marie-Therese Valovska, Carlos R. Estrada, Joseph G. Borer, Caleb P. Nelson
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Vortioxetine-Induced Amenorrhea: A Case Report
Mesut Işik, Faruk Kurhan, Tuba Ülkevan, Pinar Güzel Özdemir
Clinical Neuropharmacology.2022; 45(1): 7. CrossRef