Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Do Sugar-Sweetened Beverages Cause Obesity and Diabetes?

Do Sugar-Sweetened Beverages Cause Obesity and Diabetes?

Do Sugar-Sweetened Beverages Cause Obesity and Diabetes?

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

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

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

A Case of Gigantic Unruptured Abdominal Aneurysm Successfully Treated With Endovascular Repair (EVAR) | Annals of Internal Medicine: Clinical Cases

Aortic aneurysms are focal dilations of more than 50% the normal aortic diameter; giant abdominal aortic aneurysms (AAAs) have diameters greater than or equal to 10 cm and are rare clinical entities. We present a case of an elderly man with an AAA with a 14.6-cm diameter, treated successfully with endovascular repair (EVAR). AAAs pose anatomical challenges for EVAR because of their narrow necks, extreme angulation, and dislocation of intra-abdominal organs. A literature review shows only 5 EVARs have been attempted for the repair of giant AAAs; 4 were successful. With the technical advancement and careful patient selection, successful EVAR of giant AAAs is possible.

Recurrent Pulseless Electrical Activity Arrests Due to Coronary Vasospasm Without Obstructive Coronary Artery Disease | Annals of Internal Medicine: Clinical Cases

This case describes recurrent pulseless electrical activity arrests in a postoperative patient caused by coronary vasospasm, an underrecognized but reversible trigger of cardiac arrest. Transient ischemic electrocardiogram changes, nonobstructive coronary angiography, rapid improvement with vasodilator therapy, and recovery of left ventricular function supported the diagnosis. The case emphasizes that vasospasm can mimic acute coronary syndromes and precipitate life-threatening instability, particularly in critically ill patients. It adds to current knowledge by highlighting the need for early suspicion, careful vasopressor selection, and prompt initiation of vasodilators to prevent irreversible myocardial injury and improve outcomes.

Nutcracker Syndrome in an Adult With Recurrent Gross Hematuria Successfully Managed With Conservative Therapy | Annals of Internal Medicine: Clinical Cases

A 27-year-old man with no medical history began passing blood clots in his urine after significant weight loss. Imaging revealed nutcracker syndrome, with compression of his left renal vein by his superior mesenteric artery and aorta. His symptoms resolved after an intensive weight gain regimen. Despite maintaining his weight, his hematuria recurred 2 years later after worsening lumbar lordosis. After a period of strength and flexibility training, his symptoms never returned. This case highlights the clinically diagnostic features of nutcracker syndrome and the elements of successful conservative management in an adult.

Cold Agglutinin Syndrome Caused by Mycoplasma pneumoniae in a Recipient of a Renal Transplant | Annals of Internal Medicine: Clinical Cases

Cold agglutinin syndrome (CAS) is a secondary autoimmune hemolytic anemia caused by complement activation at low temperatures. Although Mycoplasma pneumoniae–related CAS is recognized in immunocompetent hosts, its occurrence in adult recipients of solid organ transplants is rarely reported. We describe a recipient of a renal transplant receiving tacrolimus-based immunosuppression who developed CAS after M pneumoniae infection, which presented as isolated anemia without respiratory symptoms. Hemolysis resolved with supportive care while immunosuppressive therapy was maintained. This case highlights that infection-caused, complement-mediated hemolysis can occur despite pharmacologic immunosuppression and underscores the need to consider CAS in posttransplant anemia.

Autopsy Case of Colonic Plasmablastic Lymphoma Exhibiting Unique Endoscopic Phenotypic Changes During Ulcerative Colitis Therapy | Annals of Internal Medicine: Clinical Cases

Plasmablastic lymphoma (PBL), a rare and aggressive CD20-negative B-cell lymphoma, has been increasingly recognized in individuals who are HIV-negative and who are also immunosuppressed. To our knowledge, we report the first autopsy case of a 74-year-old woman with ulcerative colitis (UC) who developed colonic PBL under immunosuppressive therapy. Serial colonoscopies demonstrated a morphologic transformation from serpiginous ulcers to elevated lesions. The patient ultimately died because of carcinomatous lymphangitis. Autopsy showed widespread metastases and numerous flat elevated lesions with lobulations throughout the colon. This case demonstrates a unique endoscopic phenotypic transition in colonic PBL, suggesting the importance of careful monitoring for timely diagnosis in immunosuppressed UC patients.

Familial Iliac Aneurysms Associated With Compound Mutations in the COL1A2 Gene | Annals of Internal Medicine: Clinical Cases

Iliac artery aneurysms are uncommon and usually asymptomatic but may undergo spontaneous dissection, rupture, and thrombosis. Aneurysmal ruptures carry a high mortality rate. Mutations in collagen-encoding genes such as COL3A1 are associated with vascular Ehlers–Danlos syndrome, including reports of familial iliac aneurysms. To our knowledge, this is the first reported case of COL1A2 mutations associated with iliac artery aneurysms. In this report, we describe a patient with iliac aneurysms associated with 2 novel missense mutations in the COL1A2 gene. Family history then revealed 3 first-degree male relatives with iliac and/or aortic aneurysms suggestive of an autosomal-dominant inheritance with high penetrance. This case adds a new gene in the collagen pathway in which mutations contribute to aneurysm formation and underscores the importance of targeted genetic testing in families with iliac aneurysms.

Persistent Hypoxemia on Home Sleep Apnea Testing Prompting Further Evaluation for Pulmonary Embolism: A Case Report | Annals of Internal Medicine: Clinical Cases

Obstructive sleep apnea is a condition characterized by recurrent upper airway collapse during sleep, which may be associated with sleep disruption and repetitive oxygen desaturations. It is diagnosed by nocturnal in-lab polysomnography or home sleep apnea testing. We present a case of an otherwise healthy individual who had home sleep apnea testing that revealed persistent, unexplained hypoxemia which, on further investigation, was found to be due to a saddle pulmonary embolism.

Coexistence of Wild-Type Transthyretin Cardiac Amyloidosis and Monoclonal Gammopathy in a Patient With Polycythemia Vera | Annals of Internal Medicine: Clinical Cases

Polycythemia vera is a type of myeloproliferative neoplasm characterized by panmyelosis, with a predominant increase in erythrocyte mass. In contrast, monoclonal gammopathy of undetermined significance is classified as a premalignant plasma cell disorder and is characterized by elevated levels of monoclonal γ-globulin without associated bone lesions or clinical symptoms. Here, we present a case of the concurrent presence of wild-type transthyretin cardiac amyloidosis—not the amyloid light-chain type—and monoclonal gammopathy of undetermined significance in a patient with polycythemia vera. This case underscores the crucial importance of preforming histologic subtyping to ensure accurate diagnosis in older patients with undiagnosed cardiac amyloidosis.

Diffuse Large B-Cell Lymphoma Presenting as Aortic Aneurysm Rupture: A Case Report | Annals of Internal Medicine: Clinical Cases

We present a rare case of diffuse large B-cell lymphoma (DLBCL) mimicking an abdominal aortic aneurysm rupture. A 78-year-old male with prior endovascular aneurysm repair presented with abdominal pain, hypotension, and renal failure. Imaging revealed a periaortic mass concerning for aneurysm leak; however, PET/CT and biopsy confirmed DLBCL. This case underscores the diagnostic challenge posed by periaortic lymphoma masquerading as vascular emergencies. Clinicians should maintain a broad differential, as early recognition may avoid unnecessary surgery and enable appropriate oncologic management.

Report of Concomitant Intracranial Cysts in Unrelated Patients With Heterozygous Germline NF1 Pathogenic Variants | Annals of Internal Medicine: Clinical Cases

Neurofibromatosis 1 (NF1) is one of the most common genetic diseases of the central nervous system. The nature of intracranial lesions that are associated with NF1 are yet to be fully defined. Arachnoid, velum interpositum, and odontogenic cysts are among the more common intracranial cystic lesions that can be congenital. Although odontogenic cysts are well known to be associated with Gorlin–Goltz syndrome, the possibilities of other genetic disorders in patients with odontogenic and other intracranial cystic lesions have continued to stir research interests. Here, we report 2 cases of unrelated patients, each patient having concurrent intracranial cystic lesions in the setting of a diagnosis of NF1. Individual I had concomitant arachnoid and odontogenic cysts in parallel with a novel heterozygous germline NF1 pathogenic frameshift variant, NF1 [NM_000267.3] c.40del (p.Val14Serfs*10). Individual II had concomitant arachnoid and vellum interpositum cysts in the context of a heterozygous likely pathogenic NF1 germline variant [NF1 (NM_000267.3) c.4265C>T, p.(Ser1422Leu)]. Our observations suggest that clinicians should consider NF1 among the differential diagnosis for intracranial cystic lesions such as arachnoid, vellum interpositum, and odontogenic cysts.