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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 6

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

Generalized Weakness Due to Hypocalcemia and Hypophosphatemia From Potent Acid Suppression | Annals of Internal Medicine: Clinical Cases

Potent gastric acid suppression can disrupt mineral homeostasis. An older woman receiving alfacalcidol developed weakness accompanied by profound hypophosphatemia with hypocalcemia and secondary hyperparathyroidism after initiation of the potassium-competitive acid blocker vonoprazan. Laboratory findings showed an elevated intact parathyroid hormone level and renal phosphate wasting, whereas her serum magnesium level was 2.7 mg/dL (reference range, 1.7–2.6 mg/dL) and her intact fibroblast growth factor 23 was 41.7 pg/mL (reference range, 19.9–52.9 pg/mL). The patient's weakness and calcium–phosphate abnormalities resolved with mineral repletion and switching from vonoprazan to a proton-pump inhibitor. This case highlights that strong acid suppression may precipitate significant calcium–phosphate derangements despite active vitamin D therapy. Early evaluation of mineral metabolism and reassessment of acid-suppressive therapy are especially important in patients with unexplained weakness.

Kikuchi-Fujimoto Disease as an Etiology for Relapsing/Remitting Fevers and Lymphadenopathy in a Patient With Dermatomyositis | Annals of Internal Medicine: Clinical Cases

Kikuchi-Fujimoto disease is a rare disease characterized by persistent fevers, tender lymphadenopathy, hyperinflammation, and histiocytic necrotizing lymphadenitis. It has been described in association with autoimmune disorders, primarily, systemic lupus erythematosus. In this case report, we describe a 33-year-old White woman in whom we recently observed an association between dermatomyositis and Kikuchi-Fujimoto disease who was treated with oral prednisone for a month with complete resolution of symptoms. We highlight the importance of considering this disease in the differential diagnosis for fevers and tender lymphadenopathy as well as the importance of multidisciplinary care and early pathologic diagnosis.

Atypical Epigastric Pain Reveals Obstructive Urosepsis in a Horseshoe Kidney | Annals of Internal Medicine: Clinical Cases

A 61-year-old woman presented with 2 days of nausea, vomiting and severe mid- to upper abdominal pain radiating to the right flank without any urinary symptoms. She was hypotensive, with leukocytosis and pyuria. Contrast-enhanced computed tomography demonstrated a horseshoe kidney and a 12- × 8- × 18-mm right ureteropelvic junction stone causing mild to moderate hydronephrosis. Blood and urine cultures were obtained before administration of antibiotics and remained negative. She received intravenous crystalloid therapy, ceftriaxone, and emergent percutaneous nephrostomy, with rapid hemodynamic recovery and normalization of leukocytosis by hospital day 1. This case highlights atypical presentations of obstructive urosepsis and the importance of early decompression.

Glomerulonephritis Caused by Bartonella quintana Endocarditis | Annals of Internal Medicine: Clinical Cases

We describe the case of a 60-year-old man who presented with rash and renal failure and was subsequently diagnosed with Bartonella quintana mitral valve endocarditis. Key findings included skin biopsy showing leukocytoclastic vasculitis, renal biopsy showing crescentic glomerulonephritis, and high-titer IgM and IgG antibodies against B quintana. This case underscores the varied presentations of culture-negative endocarditis and its association with glomerulonephritis in infectious diseases such as Bartonella.

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.

Favre–Racouchot Disease: Extensive Comedonal Lesions on Severely Photodamaged Facial Skin | Annals of Internal Medicine: Clinical Cases

Favre–Racouchot disease is a manifestation of chronic actinic damage characterized by multiple open and closed comedones on severely photodamaged skin. The accompanying images illustrate classic malar and periorbital involvement with prominent solar elastosis and absence of inflammatory acneiform lesions in an older adult Latino man (Fitzpatrick skin type IV), underscoring that this condition can occur in darker-skinned phototypes with sufficient cumulative ultraviolet exposure.

Breathless on Standing: Hepatopulmonary Syndrome in Chronic Liver Disease | Annals of Internal Medicine: Clinical Cases

In patients with chronic liver disease, positional dyspnea (platypnea) and desaturation (orthodeoxia) should prompt immediate evaluation. Although the differential diagnosis includes many cardiopulmonary disorders, platypnea-orthodeoxia raises concern for right-to-left shunting and gravity-dependent ventilation–perfusion ratio mismatch, particularly hepatopulmonary syndrome. This condition carries high mortality and requires prompt evaluation for liver transplantation. We present a patient with chronic untreated hepatitis C who developed significant platypnea and orthodeoxia. Work-up revealed a markedly elevated alveolar-arterial gradient, and contrast-enhanced (agitated saline) echocardiography demonstrated substantial intrapulmonary shunting, confirming the diagnosis.

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