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Racial Health Disparities, Prejudice and Violence

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Displaying 1 - 10 of 499 in Annals of Internal Medicine: Clinical Cases

Annals of Internal Medicine: Clinical Cases: Archive

Annals of Internal Medicine: Clinical Cases: Vol 5, No 3

Sequential Drug-Induced DRESS Syndrome With Severe Rhabdomyolysis and Probable Myocarditis: A Case Report | Annals of Internal Medicine: Clinical Cases

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe hypersensitivity syndrome with multiorgan involvement. An 81-year-old man with cardiomyopathy and stage IV chronic kidney disease developed DRESS syndrome after sequential exposure to allopurinol and vancomycin. He presented with diffuse rash, eosinophilia, transaminitis, severe rhabdomyolysis (CK 19,228 U/L), and probable myocarditis (troponin 9,712 ng/L). Corticosteroids started late, and a repeat vancomycin dose was temporally associated with rapid multiorgan deterioration and death. This case illustrates a rare presentation of DRESS syndrome with concurrent rhabdomyolysis and myocarditis, emphasizing the lethality of delayed diagnosis and sequential exposure to high-risk agents.

Cardiac Tamponade Due to Entamoeba histolytica in a Patient in a Nonendemic Region | Annals of Internal Medicine: Clinical Cases

Entamoeba histolytica infection is classically associated with intestinal disease and liver abscesses in endemic regions. Pericardial involvement with cardiac tamponade is an exceptionally rare, life-threatening complication. We present a case of a 58-year-old man in the United States with no recent travel who developed pericardial tamponade due to diaphragmatic communication with an E histolytica liver abscess. His case underscores the need to consider parasitic infections in the differential diagnosis of purulent pericardial effusions, even in nonendemic areas, and demonstrates how serologic testing and multidisciplinary collaboration were critical for diagnosis and management of this unexpected condition.

From Risk to Reality: How Pregnancy in Cystic Fibrosis Has Transformed | Annals of Internal Medicine: Clinical Cases

Spontaneous Ecchymosis as Initial Presentation of Acquired Hemophilia A | Annals of Internal Medicine: Clinical Cases

Hemophilia A, a deficiency of clotting factor VIII, can be congenital, presenting with joint bleeding in childhood, or acquired, a rare subtype presenting as spontaneous bleeding most commonly seen in older adult patients. This report outlines an older adult patient with no history of bleeding disorders who developed acute-onset spontaneous ecchymoses and was found to have acquired hemophilia A. This case demonstrates the importance of a broad differential diagnosis in ecchymoses in older adult patients that includes coagulation factor deficiencies despite a lack of hematologic history. Early diagnosis and treatment of hemophilia A with hemostatic control and inhibitor eradication are imperative to prevent life-threatening bleeding.

Insulin Autoimmune Syndrome Presenting With Recurrent Hypoglycemia and Extreme Hyperinsulinemia | Annals of Internal Medicine: Clinical Cases

Insulin autoimmune syndrome (IAS) is a rare but important cause of hypoglycemia. Herein, we describe a case of a 67-year-old White man with recurrent episodes of confusion and fatigue relieved by food intake. Biochemical evaluation revealed profound hyperinsulinemia and an elevated C-peptide level, suggesting endogenous insulin production, with no pancreatic lesion on imaging. The presence of insulin autoantibodies confirmed the diagnosis. Fluctuating beta-hydroxybutyrate levels provided an additional physiologic clue, reflecting variable insulin activity resulting from antibody binding and release. This case highlights how characteristic biochemical patterns, including variable ketone levels, can facilitate timely recognition of IAS and help avoid unnecessary diagnostic procedures.

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.

An Unusual Rash in a Febrile Adult | Annals of Internal Medicine: Clinical Cases

We report a 38-year-old man who presented with nonpruritic flagellate erythema, symmetrical polyarthritis, daily high-grade fevers, and unintentional weight loss. Skin biopsy supported the diagnosis of adult-onset Still disease (AOSD), which was established after exclusion of alternative diagnoses. The patient improved with oral corticosteroid therapy. Flagellate erythema is a rare cutaneous manifestation of AOSD, which may delay diagnosis. Awareness of this presentation is important for timely recognition and management.

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.

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