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Displaying 1 - 10 of 142 in Annals of Internal Medicine: Clinical Cases

Euglycemic Diabetic Ketoacidosis Related to SGLT2 Inhibitor Use in a Patient With Cobalamin C Deficiency and Diabetes | Annals of Internal Medicine: Clinical Cases

A 24-year-old woman with cobalamin C deficiency (CblCD), autoimmune thyroiditis, and recently diagnosed diabetes mellitus presented with weight loss, emesis, and abdominal pain. She had been placed on sodium-glucose cotransporter inhibitor (SGLT2i) therapy because of metformin intolerance, with the addition of a dipeptidyl peptidase-4 inhibitor. Biochemical analyses demonstrated severe acidosis, initially attributed to CblC-associated metabolic decompensation. Subsequent evaluation led to the diagnosis of SGLT2i-induced euglycemic diabetic ketoacidosis in a patient with type 1 diabetes mellitus. This case highlights the importance of assessing for insulin deficiency when evaluating acidosis and the management challenges of common diseases in adults with inherited metabolic disorders.

Why So Salty? Transient Diabetes Insipidus After Discontinuation of Vasopressin | Annals of Internal Medicine: Clinical Cases

In recent years, vasopressin has been increasingly used as an early treatment of vasopressor-refractory septic shock. In this article, we describe 2 episodes of transient diabetes insipidus after vasopressin for the treatment of septic shock was discontinued, which adds to a modest number of case studies reporting the same phenomenon. With the anticipated continued use of vasopressin in intensive care units, it can be expected that this adverse effect will occur with some frequency. Awareness and early recognition of this phenomenon can lead to prompt diagnosis and treatment.

Unexpected Therapeutic Effect of GLP-1 Receptor Agonists in Patients With Refractory IBS-D: A Case Series | Annals of Internal Medicine: Clinical Cases

Irritable bowel syndrome with diarrhea (IBS-D) is a common functional gastrointestinal disorder. It is primarily caused by increased intestinal transit. GLP-1 receptor agonists (GLP-1 RAs) are widely used for obesity and diabetes management. They have been shown to decrease intestinal motility as a side effect. We present a 67-year-old woman and a 23-year-old woman, both with long-standing, debilitating IBS-D. Both achieved a 22.7-kg weight loss with GLP-1 RA use. They also reported resolution of diarrhea and improved quality of life. This case series suggests potential therapeutic benefits of GLP-1 RA use in hypermotility associated with IBS-D.

An Unusual Case of Hyperosmolar Hyperglycemic State Complicated by Bilateral Occipital Lobe Seizures | Annals of Internal Medicine: Clinical Cases

Hyperosmolar hyperglycemic state (HHS) is a complication of type 2 diabetes mellitus (T2DM) marked by hyperglycemia without acidosis. We present a case of a 59-year-old woman with a history of T2DM and migraines who presented with worsening occipital headaches accompanied by visual disturbances. Her glucose level on arrival was 559 mg/dL with a normal anion gap. Magnetic resonance imaging revealed cortical restricted diffusion in the left occipital lobe. An electroencephalogram detected electroclinical focal seizures in the bi-posterior region. This case highlights the importance of both recognizing seizures in HHS and the need to consider alternative diabetes diagnoses for patients with atypical diabetic phenotypes.

Euglycemic Diabetic Ketoacidosis in a Patient Post Cardiac Surgery Receiving Continuous Renal-Replacement Therapy | Annals of Internal Medicine: Clinical Cases

Euglycemic diabetic ketoacidosis is an often-underrecognized endocrine emergency. We highlight an unusual presentation of euglycemic diabetic ketoacidosis in a patient with a history of hypertension, type 2 diabetes mellitus, and stage 3b chronic kidney disease who had elective aortic and mitral valve–replacement surgery. She developed acute kidney injury requiring temporary continuous renal-replacement therapy. Despite hemodialysis, the patient had persistent anion-gap metabolic acidosis. Additional evaluation resulted in the diagnosis of euglycemic diabetic ketoacidosis. Successful care in this patient population entails a high index of suspicion, early diagnosis, and appropriate management.

Linagliptin-Induced Pancreatitis | Annals of Internal Medicine: Clinical Cases

Incretin-based medications are well-established agents used for glycemic control in patients with type 2 diabetes mellitus. Of these medications, glucagon-like peptide 1 agonists have a well-known association with pancreatitis. However, controversy still exists about a similar association with dipeptidyl peptidase 4 inhibitors. Linagliptin, in particular, has not been studied thoroughly. Therefore, to the best of our knowledge, we report linagliptin-induced pancreatitis, the fourth case reported in the medical literature, that resolved after stopping the medication and did not recur with the resumption of all of the other patient's medications.

Pneumococcal Endocarditis, Rare but Not Forgotten | Annals of Internal Medicine: Clinical Cases

Pneumococcal endocarditis incidence has significantly decreased since the advent of antibiotics but remains a significant cause of mortality and morbidity in high-risk groups, such as those with heart disease, chronic lung and liver disease, smoking, diabetes mellitus, and immunosuppression. We present a unique case of pneumococcal endocarditis with no clinical stigmata of infective endocarditis that manifested with acute hypoxic respiratory failure and severe aortic regurgitation. A large vegetation on the aortic valve was noted during surgery, with negative blood cultures and aortic valve tissue cultures but positive Streptococcus pneumoniae urinary antigen and polymerase chain reaction (PCR) test on the aortic valve.

Severe Presentation of Acute Eosinophilic Pneumonia Possibly Secondary to Recent E-Cigarette Use | Annals of Internal Medicine: Clinical Cases

A 52-year-old man with type 2 diabetes mellitus presented with fever and hypoxemic respiratory failure requiring intubation. He had no history of pulmonary disease but recently started smoking nicotine-containing electronic cigarettes (e-cigarettes) after 10 years of tobacco abstinence. He had diffuse bilateral ground-glass opacities on chest imaging, 11% peripheral eosinophilia (absolute eosinophil count 1300/µL), and 50% eosinophilia in the bronchoalveolar lavage fluid without evidence of bacterial, viral, fungal, or parasitic infection. Hypoxia and pulmonary infiltrates rapidly resolved after initiation of high-dose corticosteroids after bronchoscopy. A diagnosis of acute eosinophilic pneumonia was made, possibly secondary to recent e-cigarette use.

A Rare Cause of Severe Hypoglycemia in Intracranial Hemangiopericytoma Associated With Non-Islet Cell Tumor Hypoglycemia | Annals of Internal Medicine: Clinical Cases

A 60-year-old man with a history of metastatic intracranial hemangiopericytoma and type 2 diabetes mellitus presented with acute episodes of confusion and dizziness. A magnetic resonance imaging scan of the brain showed progressing calvarial metastasis without intracranial abnormality. He was found to have severe persistent hypoglycemia. The initial hypoglycemia work-up revealed low serum insulin and C-peptide level and negative panel for oral hypoglycemic agents. Further laboratory testing revealed an elevated insulin-like growth factor II (IGF II):IGF-I ratio and low β-hydroxybutyrate, consistent with nonislet cell tumor hypoglycemia. The patient received prednisone and his hypoglycemia improved.

Ophthalmoplegia and Tumor Lysis Syndrome: An Uncommon Presentation of Posttransplant Lymphoproliferative Disorder | Annals of Internal Medicine: Clinical Cases

A 55-year-old man presented with 1 month of fatigue, nausea, vomiting, and weight loss, and blurry vision in his left eye. He has a history of type 1 diabetes mellitus after allogenic kidney and pancreas transplantation 15 years prior. He was found to have tumor lysis syndrome (TLS), total left-sided ophthalmoplegia and ptosis, and left cavernous, abdomen, and pelvic masses. Biopsy revealed an Epstein-Barr virus–negative diffuse large B-cell lymphoma, a type of posttransplant lymphoproliferative disorder (PTLD). It is essential to consider PTLD in transplant patients who present with TLS and compressive neurologic deficits.

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