Search Results for: "diabetes_articles"

There are multiple secondary causes of hyperlipidemia, including obstructive cholestasis. We present a patient case of a 72-year-old woman with controlled hyperlipidemia presenting for a routine primary care visit. Laboratory results showed marked hyperlipidemia. Subsequent evaluation revealed biliary obstruction resulting from pancreatic adenocarcinoma.

Diffuse Necrosis: A Rare Case of Idiopathic Black Esophagus, Duodenum, and Jejunum | Annals of Internal Medicine: Clinical Cases

Black esophagus, or acute esophageal necrosis (AEN), is a rare, life-threatening disorder that typically presents in patients who have multiple comorbid conditions and is essential to diagnose as soon as possible. Although AEN is commonly seen in patients who are critically ill, it is unusual for patients to have mild subjective symptoms and otherwise remain clinically stable. We present a peculiar case of a patient who had endoscopic findings showing extensive necrosis of his esophagus, duodenum, and jejunum with sparing of the stomach and only mild symptomatology.

Levetiracetam-Induced Pancytopenia in an HIV Seropositive Patient With SARS-CoV-2 | Annals of Internal Medicine: Clinical Cases

Levetiracetam is a widely used and safe antiepileptic drug, and levetiracetam-induced pancytopenia is an uncommon adverse effect. We present a patient case of a middle-aged man with seizures who developed profound pancytopenia within 4 days of starting levetiracetam. We suspected levetiracetam-induced pancytopenia, withdrew the levetiracetam, and started our patient on an alternative medication, which improved his blood count within 24 hours. This is the first patient case demonstrating levetiracetam-induced pancytopenia in an adult with coexisting HIV and SARS-CoV-2 infections, which did not contribute to his pancytopenia. Physicians should be cognizant of this adverse effect when prescribing levetiracetam to treat seizures.

Successful Peripartum Venoarterial Extracorporeal Membrane Oxygenation for Pheochromocytoma-Induced Cardiogenic Shock | Annals of Internal Medicine: Clinical Cases

We describe a 37-year-old multiparous woman with cardiogenic shock resulting from pheochromocytoma crisis. She had term labor induction after developing hypertension attributed to preeclampsia. Severe hemodynamic instability followed on postpartum day 2 requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). Suspicion for pheochromocytoma arose after a computed tomography scan showed a large adrenal mass, and the diagnosis was confirmed with plasma and 24-hour urine metanephrine levels. She initially had cardiomyopathy with left ventricular ejection fraction less then 10%, which rapidly improved, and she was successfully weaned off VA-ECMO. This patient case illustrates the clinical challenges concerning pheochromocytoma during pregnancy.

Successful Extracorporeal Membrane Oxygenation After a Challenging Cannulation in a Pregnant Patient With COVID-19 | Annals of Internal Medicine: Clinical Cases

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) support for fulminant COVID-19 pneumonia in a person with a viable pregnancy is controversial because many experts recommend delivery of the fetus before maternal ECMO. We describe V-V ECMO use for COVID-19 in a pregnant person at 28 weeks gestation. An inability to pass a guidewire from the jugular vein to the inferior vena cava complicated bedside ECMO cannulation, mandating a jugular-femoral 2-cannula approach that involves risk near a gravid uterus. In this case, procedural flexibility and multispecialty collaboration led to good maternal and fetal outcomes after 6 days of ECMO support.

A Case Report of Spontaneous Coronary Artery Dissection | Annals of Internal Medicine: Clinical Cases

Atherothrombosis is the leading cause of acute coronary syndrome (ACS). Spontaneous coronary artery dissection (SCAD) refers to a nonatherosclerotic lesion involving the tearing and splitting of the coronary wall. The creation of a false lumen and blockage of the true lumen generates an oxygenation mismatch in the myocardial tissue. A middle-aged woman with unremarkable medical history developed chest pain. Uptrending cardiac enzymes and electrocardiogram changes prompted further testing. Coronary angiography showed a type 3 SCAD lesion in the left circumflex artery. SCAD lacks the average risk factors of ACS and its recognition can be delayed. On the other hand, it preserves the typical presentation of ACS.

Postpartum Recurrent Mastitis Despite Resolution of Prior Prolactinoma | Annals of Internal Medicine: Clinical Cases

We present a 35-year-old woman with history of a prolactinoma who presented 11 weeks postpartum with recurrent mastitis. Per the patient, in the past she took cabergoline but stopped about 5 years previously. Despite attempts to wean, postpartum, she continued to express an excessive amount of breast milk. Magnetic resolution imaging revealed a slightly heterogeneous appearance of the pituitary gland, and she was started on dopaminergic agents. This case demonstrates that significant lactotroph hyperplasia can occur after breastfeeding ends despite the resolution of a prior prolactin-secreting microadenoma.

Cushing Syndrome Secondary to Ectopic ACTH Production in Pregnancy: A Case Report | Annals of Internal Medicine: Clinical Cases

Ectopic adrenocorticotropic hormone production is an extremely rare cause of Cushing syndrome in pregnancy and is associated with significant morbidity. A 37-year-old multiparous woman at 32 weeks’ gestation presented with hypertension, anasarca, hypokalemia, and fetal distress requiring an urgent cesarean section. Her adrenocorticotropic hormone and cortisol levels were elevated, and high-dose dexamethasone failed to suppress them, suggesting ectopic adrenocorticotropic hormone production. Multimodality imaging did not identify a source, and she had urgent bilateral adrenalectomy for refractory severe hypercortisolism. Ectopic Cushing syndrome in pregnancy requires a high index of suspicion for diagnostic testing and prompt treatment to minimize maternal and fetal complications.

Ivermectin-Clorsulon Overdose in Attempting Coronavirus Disease 2019 Prophylaxis: A Case Report | Annals of Internal Medicine: Clinical Cases

With aims of coronavirus disease 2019 (COVID-19) prophylaxis, a 60-year-old woman ingested a formulation of ivermectin and clorsulon, intended for veterinarian use, that contained 30 times the U.S. Food and Drug Administration–approved dose of ivermectin (5.4 mg/kg). She developed altered mental status requiring intubation. Symptoms were similar to other cases of supratherapeutic ivermectin ingestion. Misinformation propagated about COVID-19 prophylaxis and treatment has led to adverse effects both from misuse of medications and disregard of proven options.

Spontaneous Ectopic Paraumbilical Variceal Bleeding in a Patient With Cirrhosis | Annals of Internal Medicine: Clinical Cases

Ectopic variceal hemorrhage is a rare sequela of portal hypertension, accounting for 5% of variceal bleeding events. Although mortality rates are high for this condition, there is no established management protocol. We present a patient case of spontaneous external hemorrhage from an ectopic paraumbilical varicosity in the setting of portal hypertension secondary to decompensated alcoholic cirrhosis that was treated effectively with transjugular intrahepatic portosystemic shunt placement.

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