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Displaying 11 - 20 of 1297 in Annals of Internal Medicine
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Physiotherapy reduced recurrent headaches linked to neck pain and dysfunction in older adults
Source Citation Uthaikhup S, Assapun J, Watcharasaksilp K, Jull G. Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial. Spine J. 2016 Aug 4. [Epub ahead of print]. 27497890
In acute or subacute LBP at risk for chronicity, supported self-management reduced disability vs. medical care over 1 y
Clinical Impact Ratings GIM/FP/GP: 5 out of 7 Phys Med & Rehab: 6 out of 7
What Would You Recommend for This Patient Interested in a Total Knee Joint Arthroplasty? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Fourteen million people in the United States have symptomatic knee osteoarthritis (OA), a number that is expected to rise with an aging population. Patients with OA can benefit from nonoperative treatment. However, none of these treatments are disease modifying, and many patients eventually require total joint arthroplasty (TJA). The American College of Rheumatology and the American Association of Hip and Knee Surgeons recently issued a guideline on the optimal timing of TJA in patients with symptomatic moderate-to-severe OA for whom nonoperative therapy has been ineffective. In this article, 2 experts review the available evidence and discuss options for nonoperative treatment and the indications for and timing of operative therapy.
Displaying 11 - 20 of 90 in Annals of Internal Medicine: Clinical Cases
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.
Achromobacter Hepatic Abscess Several Months After Laparoscopic Cholecystectomy: A Case Report and Review of Literature | Annals of Internal Medicine: Clinical Cases
Achromobacter xylosoxidans is a rare pathogen that causes opportunistic and nosocomial infections in immune-compromised patients. After a cholecystectomy, dropped stones can serve as nidus for abscess formation. We describe a rare case of hepatic abscess caused by Achromobacter xylosoxidans in a 40-year-old immune-competent woman who had a laparoscopic cholecystectomy 9 months previously.
Pancreatic-Pleural Fistula in a Patient With Recurrent Pancreatitis and Unknown Pancreatic Divisum | Annals of Internal Medicine: Clinical Cases
Recurrent acute pancreatitis (RAP) affects less than 1% of the population and can rarely be associated with severe extra-abdominal complications. We herein present a case of RAP due to a congenital anomaly with a rare thoracic complication that was undiagnosed by classic imaging method to highlight a unique presentation of an uncommon clinical entity.
Three Cases of Atypical Cutaneous Ovarian Metastases: A Single-Center Case Series | Annals of Internal Medicine: Clinical Cases
Ovarian cancer rarely metastasizes to the skin, but when cutaneous metastases occur, the typical location is within the umbilicus, commonly known as a Sister Mary Joseph nodule. Extraabdominal cutaneous metastases from ovarian cancer are extremely rare. Here, we report a series of 3 patient cases at a single institution who presented with extraabdominal cutaneous ovarian metastases. We discuss the potential mechanisms for cutaneous involvement as well as histopathology, treatments, and outcomes in patients with extraabdominal cutaneous ovarian cancer metastases.
Chronic Eosinophilic Pneumonia as the Initial Manifestation of Rheumatoid Arthritis: A Case Report | Annals of Internal Medicine: Clinical Cases
Chronic eosinophilic pneumonia (CEP) is a rare disorder characterized by peripheral blood eosinophilia, increased eosinophils in bronchoalveolar lavage fluid, and eosinophilic infiltration of lung alveoli and interstitia. While only a handful of cases of CEP have been reported in rheumatoid arthritis (RA), CEP as the initial presenting manifestation of RA is extremely rare. We report a 28-year-old woman who was diagnosed with CEP in association with newly diagnosed RA, who responded to corticosteroid therapy but relapsed on steroid taper. She was later treated with mepolizumab as a steroid-sparing agent while being tapered off steroids.
Dermatitis Neglecta: A Case Report of Hyperpigmentation Resulting From Impaired Mechanical Cleansing | Annals of Internal Medicine: Clinical Cases
Dermatitis neglecta (DN) results from inadequate frictional cleansing and is often associated with psychiatric or neurologic impairments. It is frequently misdiagnosed owing to its rarity and variable presentation. We report a 71-year-old woman with extensive hyperpigmented plaques from the mid-back to posterior thighs. Initially suspected to be tinea corporis, the primary lesion did not fluoresce on Wood's lamp examination. Mechanical cleansing with soap, water, and alcohol swabbing removed the pigmentation, confirming DN. This case emphasizes the importance of recognizing DN, particularly in patients with functional limitations, to avoid unnecessary testing and ensure effective management.
Rifampin-Induced Loss of Glucocorticosteroid Therapeutic Effect | Annals of Internal Medicine: Clinical Cases
Drug–drug interactions between rifampin and glucocorticosteroids are uncommonly reported in the literature but can have significant impact on patient management. We report a case in which this drug–drug interaction complicated the management of a patient with active lupus arthritis flare on prednisone changing to biological therapy with concurrent rifampin given for latent tuberculous infection. Lack of therapeutic response to prednisone with subsequent control of her flare was finally achieved by discontinuing rifampin and changing to methylprednisolone and rituximab given that use of B-cell–directed biological therapy does not require concomitant latent tuberculosis treatment. This case underscores the importance of conducting a thorough evaluation of medications for any potential drug–drug interactions in immunosuppressed individuals.
Tremors and Memory Loss From Hypomagnesemia and Hypocalcemia Secondary to Long-Term Proton Pump Inhibitor Use | Annals of Internal Medicine: Clinical Cases
Proton pump inhibitors (PPIs) are commonly prescribed for short-term use but are often taken chronically, including through over-the-counter (OTC) access. Long-term use has been linked to hypomagnesemia and hypocalcemia, which may cause serious complications. A 47-year-old man on PPIs for 5 years presented with cramps, spasms, tremors, disorientation, and amnesia. Tests showed low magnesium and calcium, with other causes excluded. Proton pump inhibitor treatment was discontinued and supplementation initiated, leading to marked recovery. Chronic PPI use should be considered in unexplained electrolyte abnormalities, even in patients not at high risk, highlighting the need for cautious prescribing, periodic monitoring, and reassessment of OTC availability.
Persistent Nasal Cellulitis Revealing Extranodal Natural Killer/T-cell Lymphoma | Annals of Internal Medicine: Clinical Cases
Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL-NT) is a rare and aggressive non-Hodgkin lymphoma. We present a case of ENKTCL-NT in a previously healthy 37-year-old man who initially presented with persistent nasal cellulitis unresponsive to antibiotics. Despite incision and drainage plus antibiotic treatment of presumed infection, his condition worsened. After disease progression, nasal biopsy revealed angioinvasive, Epstein–Barr virus–associated ENKTCL-NT 1 month after initial presentation. This case underscores the importance of maintaining a broad differential diagnosis for refractory sinonasal symptoms, particularly among internists evaluating Latin American patients, and highlights the critical role of early biopsy in identifying this aggressive malignancy.
Posterior Reversible Encephalopathy Syndrome in an Older Patient in the COVID-19 and Paxlovid Era | Annals of Internal Medicine: Clinical Cases
Nirmatrelvir/ritonavir (Paxlovid) has been prescribed increasingly for treatment of COVID-19. Due to ritonavir's inhibition of CYP3A4, there are many medication interactions to consider. In this case, a 63-year-old woman recently treated with Paxlovid presented with symptoms mimicking previous episodes of lupus cerebritis. Imaging, however, revealed a pattern more consistent with posterior reversible encephalopathy syndrome. When Paxlovid therapy was initiated in the ambulatory setting, her amlodipine dose was decreased due to concern for interactions. Since Paxlovid is recommended for patients with high risk for progression to severe illness, this poses a unique challenge, especially in older patients with multiple comorbid conditions.