Moderate Alcohol Intake and Cardiometabolic Risk in Adults With Type 2 Diabetes

Moderate Alcohol Intake and Cardiometabolic Risk in Adults With Type 2 Diabetes

Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus

Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus

Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus

Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes

Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes

In higher-risk, statin-intolerant adults with diabetes, bempedoic acid reduced MACE at a median 3 y

Source Citation Ray KK, Nicholls SJ, Li N, et al; CLEAR OUTCOMES Committees and Investigators. Efficacy and safety of bempedoic acid among patients with and without diabetes: prespecified analysis of the CLEAR Outcomes randomised trial. Lancet Diabetes Endocrinol. 2024;12:19-28. 38061370

In adults with overweight or obesity and CVD, but without diabetes, semaglutide reduced MACE at a mean 40 mo

Source Citation Lincoff AM, Brown-Frandsen K, Colhoun HM, et al; SELECT Trial Investigators. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389:2221-2232. 37952131

In adults with BMI ≥27 kg/m2 and type 2 diabetes, adding tirzepatide to a lifestyle intervention increased weight loss at 72 wk

Source Citation Garvey WT, Frias JP, Jastreboff AM, et al; SURMOUNT-2 investigators. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2023;402:613-626. 37385275

Double Coronary–Cameral Fistula: Right Coronary Artery and Circumflex to Left Atrium | Annals of Internal Medicine: Clinical Cases

Coronary fistulas are an abnormal communication of the coronary arteries with the cardiac chambers or any vascular structure. Most are detected incidentally. Transthoracic echocardiogram is essential for evaluation, coronary computed tomography angiography can be useful in planning the procedure, allowing excellent anatomical delineation, and cardiac magnetic resonance imaging can help to outline the anatomy; however, the gold standard is coronary angiography. Treatment can be pharmacologic, surgical, or transcatheter. We present the case of a 71-year-old woman with angina and dyspnea in whom the diagnostic approach demonstrated the presence of coronary–cameral fistulas for which pharmacologic management was decided.

Pain as a Clinical Presentation of Osteopoikilosis | Annals of Internal Medicine: Clinical Cases

Osteopoikilosis, or disseminated condensing osteopathy, is an osteosclerosing dysplasia that is a rare genetic disorder of autosomal-dominant genetic transmission, and recent research suggests that the possible cause of osteopoikilosis might be the loss of function of the LEM domain-containing gene 3 (LEMD3). We describe the case of a young man with arm pain associated with increased volume, functional limitation, and fever who presented to the emergency department. Radiographic and magnetic resonance images are provided, which reveal bilateral periarticular osteosclerotic lesions in the pelvis, humeral head, and scapular region, showing no signs of malignancy.

Tacrolimus Toxicity in Two Renal Transplant Recipients Treated With Nirmatrelvir/Ritonavir: A Case Series | Annals of Internal Medicine: Clinical Cases

Since the onset of the SARS-CoV-2 (COVID-19) pandemic, significant effort has been devoted toward developing therapeutics that decrease the morbidity and mortality of COVID-19 infection. The antiviral nirmatrelvir/ritonavir (Paxlovid) has shown success in reducing hospitalization and death in patients with mild-to-moderate COVID-19 infection. However, enthusiasm over nirmatrelvir/ritonavir's ability has been met with caution as the result of potential drug–drug interactions. Here, we present 2 cases of tacrolimus toxicity, both in renal transplant recipients, following nirmatrelvir/ritonavir use. These cases are significant because, although the potential for pharmacologic interactions with nirmatrelvir/ritonavir is known, few cases of actual harm have been documented.

Left-Sided Acute Appendicitis With Situs Inversus Totalis | Annals of Internal Medicine: Clinical Cases

Left-sided appendicitis is difficult to diagnose, but a delayed diagnosis may have a fatal outcome. We describe a patient case of acute appendicitis with situs inversus totalis and left lower quadrant abdominal pain. Unexpected faint heart sounds in their typical location and chest radiograph demonstrating dextrocardia prompted the suspicion of situs inversus totalis and left-sided appendicitis.

Widespread Coronary Aneurysm Formation Due to Hypereosinophilic Vasculitis | Annals of Internal Medicine: Clinical Cases

Hypereosinophilic vasculitis, a variant of eosinophilic granulomatosis with polyangiitis, affects small- and medium-sized arteries. Cardiac involvement may manifest as heart failure, pericarditis, or valvular insufficiency (1, 2). Eosinophilia affects the endothelium and microvasculature, leading to thrombosis and fibrosis involving the endocardium and valves (3). Coronary artery aneurysms due to hypereosinophilia are extremely rare and have been reported sparsely in the literature (4, 5). Here, we describe a patient with hypereosinophilic vasculitis and widespread coronary artery aneurysms.

Incidentally Detected Chronic Left Ventricular Pseudoaneurysm After Subacute Inferior–Posterior Myocardial Infarction | Annals of Internal Medicine: Clinical Cases

We describe a 69-year-old man with subacute inferior myocardial infarction who had surgical repair for a left ventricular (LV) pseudoaneurysm incidentally detected by routine 6-month follow-up echocardiography. Although LV pseudoaneurysm is a rare complication after myocardial infarction, the delayed diagnosis and management can cause adverse patient outcomes. The present case suggests that patients with multiple risk factors for LV pseudoaneurysms, including advanced age, late presentation, and delayed revascularization, should receive intensive blood pressure control and closer examination using a multimodal imaging approach for early detection of aneurysmal formation and complications.

Vasculitis After a Vaccine: Rare Adverse Reaction Following a COVID-19 Vaccine | Annals of Internal Medicine: Clinical Cases

Fatigue, fever, localized soreness, urticaria, and rash are common adverse reactions of COVID-19 vaccines. However, the occurrence of serious autoimmune reactions is quite rare. Cutaneous small-vessel vasculitis is an autoimmune disorder that manifests with palpable purpura and petechiae involving extremities. It results from neutrophilic inflammation within and around dermal vessels and is usually self-limited. We report a 55-year-old woman presenting with a rash 48 hours after receiving the third (Moderna) COVID-19 vaccine dose. Blood investigations and a skin punch biopsy confirmed the diagnosis of COVID-19 vaccine–induced cutaneous small-vessel vasculitis. The patient ultimately improved after inpatient treatment with systemic steroids.

Blastic Plasmacytoid Dendritic Cell Neoplasm Mimicking Erythema Nodosum: A Case Report | Annals of Internal Medicine: Clinical Cases

Blastic plasmacytoid dendritic cell neoplasm (BPDCN), previously known as blastic natural killer cell lymphoma, is a rare, difficult-to-diagnose, and aggressive hematologic malignancy. Skin lesions are the initial presentation of BPDCN in 64% to 77% of cases, characterized by brown to purple nodular or bruised macular lesions in solitary or multiple locations. Here, we report the case of a 57-year-old man who initially presented with refractory erythema nodosum symptoms, including fever, arthritis, and painful erythema, and was finally diagnosed with BPDCN after a second skin biopsy. This case illustrates that skin lesions caused by BPDCN mimic ordinary erythema nodosum.

Scurvy's Systemic Clinical Picture: A Multiorgan Presentation of a Conspicuous Disease | Annals of Internal Medicine: Clinical Cases

A man whose diet was limited to consumption of chicken, fish, and bread was admitted for weight loss, dyspnea, and cutaneous lesions. Findings of the physical examination included lower-extremity purpura. Initial work-up demonstrated severe ferropenic anemia, hyperbilirubinemia, vertebral fracture, and dilation of the inferior vena cava and right cardiac chambers. Vitamin C deficiency was documented and, after adequate supplementation, the anemia, hyperbilirubinemia, and bleeding resolved. This case demonstrates the wide, unspecific, and reversible systemic manifestations associated with scurvy, its potential as a great mimicker, and the relevance of nutritional deficiencies even in an apparently nutrient-rich environment.

Reversible Improvement of Arterial Stenosis and Wall Thickness in Takayasu Arteritis Through Treatment With Tocilizumab | Annals of Internal Medicine: Clinical Cases

Early diagnosis and initiation of treatment in Takayasu arteritis (TA) is important to prevent irreversible arterial changes. A 39-year-old female was diagnosed with active TA. Subcutaneous administration of tocilizumab (162 mg/week) was initiated in combination with prednisolone (30 mg/d). After 21 months, the carotid arterial stenosis and wall thickness had normalized with only slight plaque on echocardiography. After 23 months, computed tomography showed normalization of the overall aortic stenosis and wall thickness. The prednisolone dosage could be reduced to 2 mg/d without relapse for >2 years. Early combination treatment of TA with tocilizumab prevented and normalized vascular stenosis and wall thickness.