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Racial Health Disparities, Prejudice and Violence

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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 3

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.

Insights From a Case of MRSA Enterocolitis in the Setting of Rectal Cancer | Annals of Internal Medicine: Clinical Cases

Methicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of infectious enterocolitis. We present a patient undergoing chemoradiation for rectal squamous cell carcinoma who presented with acute watery diarrhea, neutropenia, and radiographic findings consistent with colitis. Failure to improve with empirical antibiotics prompted readmission and repeat stool culture, which resulted with heavy growth MRSA responsive to oral vancomycin. Low clinical suspicion for MRSA as the causing agent led to a delay in appropriate antibiotics and prolonged hospitalization, which ultimately resulted in death. In patients who are immunocompromised with active malignancy and undifferentiated infectious enterocolitis, early MRSA screening and empirical coverage should be considered.

Left Wrist Osteomyelitis Secondary to Mycoplasma orale: A Case Report | Annals of Internal Medicine: Clinical Cases

Mycoplasma orale is a fastidious oropharyngeal commensal that rarely causes invasive disease. We report a 73-year-old immunocompromised man with destructive, culture-negative wrist osteomyelitis/septic arthritis refractory to multiple antibiotic regimens. Broad-range bacterial polymerase chain reaction at 2 independent reference laboratories concordantly identified M orale. He had staged surgical debridements and received a short course of high-dose daptomycin selected on the basis of in vitro susceptibility data, with resolution and no recurrence. This case underscores early molecular diagnostics and suggests daptomycin, alongside aggressive source control, as a salvage option when conventional Mycoplasma-active regimens fail.

The Pacemaker Cable as an Unexpected Cause of Recurrent Pulmonary Embolism | Annals of Internal Medicine: Clinical Cases

Recurrent pulmonary embolism (PE) is uncommon. We report a 39-year-old man with a pacemaker who developed recurrent PEs while receiving rivaroxaban, warfarin, and therapeutic enoxaparin. Evaluation for autoimmunity and thrombophilia was negative. Each episode was preceded by fever, malaise, and myalgia. During admission, 18-fluorodeoxyglucose positron emission tomography–computed tomography (18FDG PET/CT) showed focal uptake (maximum standardized uptake value, 2.3) along the right-ventricular pacemaker lead, suggesting device-related infection or thrombosis. Transvenous extraction failed; subsequently, surgical removal was performed. Cultures remained negative. This case highlights pacemaker-associated infection as a treatable cause of septic embolization and underscores the diagnostic value of 18FDG PET/CT in recurrent PE.

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