Search Results for: "depression"

Drug-induced cystoid macular edema (CME) is a recognized complication of systemic medications. However, its association with proprotein convertase subtilisin/kexin type 9 inhibitors has not been described previously. We describe 2 cases of CME developing after initiation of evolocumab therapy. Both patients experienced resolution following discontinuation of the medication. The cases represent a probable de novo drug-induced CME and possible precipitating effect of evolocumab in a susceptible eye. Both cases demonstrated CME resolution following evolocumab discontinuation, with no clearly identifiable alternative cause. We hypothesize that evolocumab may predispose to CME development via a vasogenic mechanism affecting blood–retinal barrier integrity. The findings warrant further pharmacovigilance.

Correction: Retatrutide-Induced Intractable Diarrhea | Annals of Internal Medicine: Clinical Cases

When Cancer Pulls the Bowel In: Intussusception in a Young Adult Man | Annals of Internal Medicine: Clinical Cases

Adult intussusception is a rare cause of bowel obstruction. Unlike pediatric cases, which are common and usually idiopathic, adult intussusception accounts for approximately 5% of all cases and causes about 1% of bowel obstructions. It is almost always associated with a structural lead point, with malignancy accounting for up to 50% of cases. Clinical presentation is often nonspecific, leading to delayed diagnosis and increased morbidity. We present the case of a 28-year-old man with colocolonic intussusception caused by poorly differentiated invasive mucinous adenocarcinoma of the colon in the absence of family history or constitutional symptoms.

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.

Lymphomatoid Granulomatosis: Pulmonary, Neurologic, and Cutaneous Involvement—Between Infection and Cancer | Annals of Internal Medicine: Clinical Cases

Lymphomatoid granulomatosis is a rare entity associated with a relatively common virus: Epstein–Barr. The virus can induce a B-cell lymphoproliferative disorder with the characteristic histopathologic finding of lymphocytic invasion of vascular walls. The lung is the organ most affected; however, the skin and central nervous system also may be involved. Management remains challenging and must be individualized because no consensus exists regarding optimal therapy. This case report of a patient with lymphomatoid granulomatosis who presented initially with dermatologic and pulmonary involvement and who later developed neurologic compromise aims to highlight this multisystem association to encourage timely biopsy and increase diagnostic yield.

Terminal Kidney Failure in a Patient With Renal Involvement of Chronic Lymphocytic Leukemia | Annals of Internal Medicine: Clinical Cases

Chronic lymphocytic leukemia (CLL) rarely causes clinically significant renal involvement, particularly in early-stage disease. We report a patient with Binet stage A CLL who developed progressive renal dysfunction due to probable diffuse leukemic infiltration of the kidneys. Diagnostic evaluation included blood studies, urinalysis, and ultimately kidney biopsy confirming dense interstitial accumulation of CD20−/CD23+ B cells. Ibrutinib therapy was well tolerated but kidney function did not recover. This case highlights that even low-stage CLL may present with organ infiltration and that unexplained renal impairment warrants early consideration of leukemic involvement.

Decoding a Case of Mpox Mimicry in a Patient With Fever and Bloody Diarrhea | Annals of Internal Medicine: Clinical Cases

Mpox, a zoonotic infection increasingly reported outside endemic regions, can mimic other sexually transmitted and enteric infections. We describe a 21-year-old HIV-negative man who presented with fever, bloody diarrhea, and a pustular rash. Work-up revealed co-infection with herpes simplex virus type 1 proctitis, Campylobacter jejuni colitis, and group A Streptococcus bacteremia. Despite antiviral therapy, persistent rash led to biopsy-confirmed Mpox. The patient recovered with supportive care alone. This case underscores the diagnostic challenges posed by overlapping infections and highlights the need to consider Mpox in atypical proctitis and rash presentations among at-risk populations.

An Unrecognized Case of Glanzmann Thrombasthenia Associated With Gastrointestinal Bleeding | Annals of Internal Medicine: Clinical Cases

Glanzmann thrombasthenia (GT) is a rare autosomal-recessive platelet disorder caused by deficiency or dysfunction of glycoprotein IIb/IIIa, resulting in defective aggregation and mucocutaneous bleeding. We report a 22-year-old Egyptian man presenting with gastrointestinal bleeding, severe anemia, and lifelong unexplained bleeding. Endoscopy revealed edematous gastropathy with postbiopsy bleeding exacerbation. Common coagulopathies were excluded and platelet aggregation tests showed absent responses to adenosine diphosphate, collagen, and arachidonic acid, confirming GT by flow cytometry. He was successfully treated with recombinant activated factor VII and tranexamic acid. This case underscores the importance of considering GT in patients with unexplained mucocutaneous bleeding and normal coagulation.

Retatrutide-Induced Intractable Diarrhea | Annals of Internal Medicine: Clinical Cases

Gastrointestinal symptoms accompanying the use of glucagon-like peptide-1 (GLP-1) receptor agonists and glucose-dependent insulinotropic polypeptide receptor-GLP-1 receptor co-agonists have been extensively catalogued. This case report contains a dramatic presentation of unintended consequences from the use of a novel triple-hormone receptor agonist and points toward the need for increased regulatory measures regarding the marketing of these treatments.

Attenuated Cardiac–Ocular Phenotype of Sanfilippo Syndrome (MPS IIIA) Presenting With Hypertrophic Cardiomyopathy and Cone-Rod Dystrophy | Annals of Internal Medicine: Clinical Cases

We describe a 39-year-old woman with cone-rod dystrophy and hypertrophic obstructive cardiomyopathy complicated by an apical aneurysm, ventricular tachycardia, and ischemic stroke, ultimately requiring heart transplantation. Histopathology revealed myocardial storage vacuoles, and biochemical and genetic testing confirmed Sanfilippo syndrome type IIIA (MPS IIIA) with 1 known pathogenic and 1 novel likely pathogenic SGSH mutation. This case illustrates an attenuated cardiac–ocular phenotype of MPS IIIA and emphasizes the need to consider late-onset lysosomal storage disorders in adults with unexplained hypertrophic cardiomyopathy.

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