Search Results for: "diabetes_articles"

Hepatic artery thrombosis (HAT) outside the setting of liver transplantation is exceedingly rare. Few cases of HAT leading to hepatic infarction have been reported, and management strategies have varied from symptom control to anticoagulation and antiplatelet therapy. Cases of spontaneous HAT without hepatic dysfunction, however, have not been previously reported. We report the case of an incidentally found spontaneous HAT without signs of hepatic dysfunction or injury in an otherwise healthy 45-year-old woman. Treatment consisted of therapeutic anticoagulation and antiplatelet therapy. Resolution of the HAT was confirmed by follow-up ultrasound imaging, and the patient remained free of HAT at 12-month follow-up magnetic resonance imaging.

Pulmonary Mucormycosis With Dissemination: A Case of Unrelenting Fever and Chest Pain | Annals of Internal Medicine: Clinical Cases

Pulmonary mucormycosis is a rare entity that requires a high index of clinical suspicion for diagnosis. Untreated mucormycosis results in dissemination with exceedingly high mortality rates. Here, we present the patient case of a previously healthy 21-year-old man who presented with fever, dyspnea, chest pain, and progressive pulmonary consolidation. This patient case highlights the expanded differential diagnosis of presumed bacterial pneumonia that fails to respond to initial management and details the clinical, radiographic, and pathologic findings consistent with diagnosing pulmonary mucormycosis.

Acute Severe Hyperlipidemia Leading to a Diagnosis of Pancreatic Cancer in an Elderly Woman | Annals of Internal Medicine: Clinical Cases

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.

A Case Report of Postheart Transplant Epicardial Adipose Deposition in a Patient With Dunnigan Syndrome | Annals of Internal Medicine: Clinical Cases

Dunnigan syndrome is a rare genetic disorder that is a type of familial partial lipodystrophy. In some patients, severe cardiomyopathy and heart transplantation have been reported in this syndrome. Here, we describe a 40-year-old patient with Dunnigan syndrome who underwent heart transplantation for end-stage heart failure. Post-transplantation, routine imaging showed an accumulation of epicardial adipose tissue around the heart. In general, in Dunnigan syndrome, epicardial fat accumulation is not different compared with that of the general population. This is the first case report of exaggerated accumulation of adipose tissue around the heart causing subtle pericardial tamponade physiology.

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.

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