Search Results for: "diabetes_articles"

A 62-year-old man with myelodysplastic syndrome presented with fever, leukocytosis, and a violaceous lesion on his right leg. His skin lesion worsened, and his fever persisted despite him receiving broad-spectrum antibiotics and multiple surgical debridements for a presumptive diagnosis of necrotizing fasciitis. Through careful review of histopathologic findings and his clinical presentation, he was subsequently diagnosed with pyoderma gangrenosum (PG). This case highlights an important diagnostic challenge. PG should be suspected in cases of nonresolving soft-tissue infection, particularly in the context of associated systemic disease, negative microbiological results, and negative work-up for autoimmune and malignant conditions.

Human Disease Caused by Kalamiella piersonii | Annals of Internal Medicine: Clinical Cases

Rare or unusual bacteria in blood cultures can be a diagnostic challenge. Here, we report a case of Kalamiella piersonii, a novel gram-negative Enterobacterales belonging to the proposed genus Kalamiella gen nov in the Erwiniaceae family. A 56-year-old woman with a medical history of end-stage nonischemic cardiomyopathy, receiving milrinone through a tunneled catheter, presented to our emergency department with chills and was found to be bacteremic with gram-negative bacilli identified as K piersonii. She was treated with 14 days of intravenous piperacillin-tazobactam without complications.

Severe Rhabdomyolysis After COVID-19 Vaccine | Annals of Internal Medicine: Clinical Cases

A 65-year-old man presented with muscle pain and muscle weakness lasting 1 week that started after his second BNT162b2 COVID-19 vaccine. He had been taking rosuvastatin and gemfibrozil for several years. He was diagnosed with acute kidney failure caused by rhabdomyolysis resulting from a statin-fibrate interaction from a COVID-19 vaccination and was admitted for continuous venovenous hemodiafiltration. Rhabdomyolysis following messenger RNA COVID-19 vaccination is a rare but important adverse event in patients using high-dose statins combined with fibrates. Such patients should be warned to seek medical attention in case of ongoing muscle symptoms after vaccination.

Immune Checkpoint Inhibitor Use in Microscopic Colitis | Annals of Internal Medicine: Clinical Cases

Immune checkpoint inhibitors (ICIs) are a novel class of anticancer therapies that can result in autoimmune pathology known as immune-related adverse events (irAEs). Because of the risk for irAEs, patients with preexisting autoimmune diseases have been excluded from safety trials for ICIs. Although the pathophysiology of microscopic colitis is not fully understood, it is considered part of the spectrum of immune-mediated gastrointestinal diseases. Little is known about the effects of ICIs on patients with microscopic colitis. This case series describes 4 patients with microscopic colitis requiring ICIs for cancer therapy and gastrointestinal-related outcomes after ICI therapy.

An Uncommon Cause of Cardiac Arrest: Tamponade Secondary to Malignant Pericardial Effusion From Myxoid Sarcoma | Annals of Internal Medicine: Clinical Cases

Primary tumors involving the pericardium are rare and often are incidentally discovered with transthoracic echocardiography. These tumors cause complications from obstruction of cardiac function with hemodynamic instability. We present a case of a 30-year-old man with primary myxoid sarcoma that resulted in cardiac arrest from malignant pericardial effusion. Despite partial resection and chemotherapy, the patient died. Despite being rare, with a 2-year survival of 60%, it is important for clinicians to be able to recognize complications from this tumor. Although no formal guidelines exist, performing surveillance echocardiography in this patient population could prevent some complications.

Antineutrophil Cytoplasmic Antibody–Associated Orbital Inflammatory Syndrome Without Extraocular Manifestations | Annals of Internal Medicine: Clinical Cases

The differential diagnosis of acute visual loss includes many ischemic, infiltrative, and rheumatologic etiologies. We present a case of antineutrophil cytoplasmic antibody (ANCA)-associated orbital inflammatory syndrome without extraocular manifestations. Initial complaints were vision loss and pain during mastication. Giant cell arteritis was suspected, but biopsy was negative. On withdrawal of steroids, symptoms returned and a head computed tomography scan showed an orbital pseudotumor. Testing showed strongly positive c-ANCA, and symptoms resolved after pulsed steroids. The patient was discharged with a probable diagnosis of ANCA-associated orbital inflammatory syndrome, prednisone, and methotrexate. This case highlights the importance of an extensive work-up in the evaluation of acute visual loss.

Hospital Stay Considerations in Hypermobile Ehlers-Danlos Syndrome: An Exemplary Case With Insights for Coexisting Symptoms | Annals of Internal Medicine: Clinical Cases

Ehlers-Danlos syndrome, hypermobility type, is a complex medical condition understood to be a genetic disorder resulting in abnormal collagen synthesis. It is characterized by joint hypermobility as well as skin laxity, poor wound healing, and other manifestations. It may present in conjunction with autonomic, neurologic, and immune abnormalities. Hypermobility spectrum disorder is similarly characterized by joint hypermobility but holds less extensive diagnostic criteria. When in the hospital setting, systemic differences resulting from hypermobility syndromes must be recognized to avoid harm. Here, we present the first case, to our knowledge, of a full hospital course with hypermobility syndrome–comorbidity-related complications described.

Sensing Error in Respironics Continuous Positive Airway Pressure Machine Risks Compromising Patient Compliance | Annals of Internal Medicine: Clinical Cases

We report a continuous positive airway pressure (CPAP) machine malfunction that may compromise patient compliance. A patient's Respironics DreamStation machine (Philips Respironics) was observed to sense “vibratory snore” events incorrectly, resulting in pressure increases that led to poor mask fit, large air leaks, and patient discomfort. A replacement machine developed the same problem. Once aware of the defect, we observed it in 2 other patients. The manufacturer acknowledges receiving a few similar reports, but our experience suggests that this may be an underreported defect. The resulting increased pressures reduce patient tolerance for CPAP. This may be an unrecognized cause for patients abandoning CPAP therapy.

Renal Sarcoidosis Presenting as Fanconi Syndrome | Annals of Internal Medicine: Clinical Cases

Fanconi syndrome is an extremely rare complication of renal sarcoidosis. We describe a case of biopsy-proven granulomatous interstitial nephritis secondary to sarcoidosis with the rare presenting feature of Fanconi syndrome. Our patient successfully received steroids initially, followed by mycophenolate and infliximab. These findings provide clinicians an important insight in recognizing this rare complication of sarcoidosis and opportunity to consider alternative regimens that can avoid or reduce side effects of first-line steroid therapy.

Concurrent Infective Endocarditis and Empyema From Salmonella arizonae | Annals of Internal Medicine: Clinical Cases

Although often associated with gastroenteritis, up to 30% of Salmonella infections are extraintestinal. Fewer than 50 cases of Salmonella empyema have been reported in the past century, and less than 2.9% of bacterial endocarditis cases are attributed to Salmonella species. Salmonella enterica subspecies arizonae generally causes mild disease and has been associated with reptiles or products containing rattlesnakes. We report the patient case of a 38-year-old man who presented to the hospital in septic shock and was found to have concurrent Salmonella bacteremia, endocarditis, and empyema with subspecies arizonae.

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