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Racial Health Disparities, Prejudice and Violence

Racial disparities, discrimination, harassment & violence are public health issues. Learn how ACP is committed to combatting racial disparities in health care.

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MATILDA KOVAL MEDICAL CENTER

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Baltimore Medical System is committed to providing quality health care

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Displaying 1 - 10 of 500 in Annals of Internal Medicine: Clinical Cases

Annals of Internal Medicine: Clinical Cases: Archive

Annals of Internal Medicine: Clinical Cases: Vol 5, No 5

Correction: Precision in Crisis: A Case Study on the Diagnostic Pitfalls in Acute Aortic Dissection | Annals of Internal Medicine: Clinical Cases

Correction: Uremic Pericarditis as a Complication of Coral Reef Aorta | Annals of Internal Medicine: Clinical Cases

Necrotizing Cavitary Pneumonia by Serratia marcescens in a Patient Treated With Dupilumab: Correlation or Causation? | Annals of Internal Medicine: Clinical Cases

Serratia species are gram-negative bacilli causing opportunistic and nosocomial infections, often in patients who are immunocompromised. A 61-year-old man with severe asthma receiving dupilumab presented with fever and chills. A chest computed tomography scan revealed bilateral cavitary lesions suggestive of necrotizing pneumonia. Bronchoalveolar lavage grew Serratia marcescens, and he was treated with prolonged antibiotics. Serratia marcescens should be considered in necrotizing pneumonia, even in patients who are immunocompetent, with dupilumab potentially as the inciting factor.

Rocky Mountain Spotted Fever–Associated Myocarditis | Annals of Internal Medicine: Clinical Cases

A previously healthy 23-year-old enlisted man presented for 2 days of fever, gastrointestinal symptoms, cough, and disseminated rash involving the palms and soles. Initial evaluation revealed leukocytosis, elevated liver enzymes, and hyponatremia. Despite antibiotic therapy for pneumonia, his condition worsened, with development of bilateral pleural effusions and myocarditis. After treatment with doxycycline, methylprednisolone, and furosemide, his symptoms improved. He completed a 7-day antibiotic course. Rocky Mountain spotted fever serology was positive 5 weeks after symptom onset. This case highlights the importance of maintaining a broad differential diagnosis and remaining vigilant for atypical presentations of infections to prevent life-threatening complications.

Pott Puffy Tumor: A Rare Disorder of Childhood Presenting With New Seizures in an Adult | Annals of Internal Medicine: Clinical Cases

Pott puffy tumor (PPT) is defined as frontal bone osteomyelitis associated with subperiosteal abscess resulting from sinus disease, which occurs most commonly in the pediatric population. This case report details a 62-year-old man who developed fever, seizures, and encephalopathy and was ultimately diagnosed with PPT, making him both the oldest adult documented with this condition, as well as the first adult documented to present with seizures, to the best of our knowledge. Clinicians should include PPT on their differential diagnosis for adults presenting with fevers and seizures, as prompt management of frontal bone osteomyelitis is critical to preventing associated central nervous system complications.

Meningitis Caused by Campylobacter jejuni in a Patient With Immunodeficiency Due to Bispecific Antibody Therapy | Annals of Internal Medicine: Clinical Cases

Bispecific antibodies, such as talquetamab and teclistamab, offer promising treatment options for refractory multiple myeloma but are associated with significant immunosuppression and susceptibility to atypical infections. We report a case of recurrent Campylobacter jejuni meningitis in a 44-year-old man undergoing talquetamab and teclistamab therapy, highlighting the role of hypogammaglobulinemia in disease recurrence. Diagnosis was confirmed using molecular tools, emphasizing their value in detecting pathogens with low bacterial loads. This case underscores the need for vigilance, advanced diagnostics, and tailored prophylaxis to mitigate infection risks in immunocompromised patients receiving novel therapies.

Hydropneumopericardium Due to Esophageal-Pericardial Fistula: A Rare Complication of Esophageal Stenting | Annals of Internal Medicine: Clinical Cases

We present a case of a 53-year-old woman with a history of ulcerative esophagitis and esophageal stricture status post esophageal stenting that was complicated by stent migration. She presented with fatigue, melena, and dark output from her percutaneous endoscopic gastrostomy tube. An echocardiogram showed hydropneumopericardium with cardiac tamponade physiology requiring emergent pericardiocentesis. The aspirated fluid was brown and cloudy; pathology of the fluid showed meat and vegetable matter consistent with food. She ultimately required esophagectomy with esophagostomy. This case highlights the importance of early recognition of esophageal-pericardial fistulas, as delay in the management carries a high risk for morbidity and mortality.

Mucocutaneous Leishmaniasis Causing Airway Compromise | Annals of Internal Medicine: Clinical Cases

A 37-year-old man presented with dyspnea and erythematous, nodular facial lesions. An examination revealed nasopharyngeal edema, and imaging showed prevertebral swelling. An extensive infectious and autoimmune evaluation was negative. A cheek biopsy was done, and polymerase chain reaction was positive for Leishmania braziliensis, confirming the diagnosis of mucocutaneous leishmaniasis. This is a progressive manifestation of a parasitic infection by Leishmania spp. It may present several years following resolution of an initial cutaneous infection. In this case, 26 years. Negative serology for leishmaniasis does not exclude active disease, and a high index of suspicion leads to early diagnosis and treatment.

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