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The triad of pancreatitis, hypoglycemia, and lactic acidosis is a rare adverse effect after linezolid administration. We report the case of a 41-year-old woman treated with oral linezolid for a filler-related Mycobacterium abscessus soft tissue infection. Three weeks after linezolid initiation, the patient presented in the emergency department, where a diagnosis of acute pancreatitis was made. Hyperlactatemia and hypoglycemia were relevant laboratory findings and potential causes were excluded. The patient rapidly deteriorated to shock and multiorgan failure, which led to patient death in 24 hours. Four similar cases have been reported, implicating linezolid-induced mitochondrial toxicity as the likely cause.

A Rare Case of Tirzepatide-Induced Hepatitis: Causality Assessment With the RUCAM Criteria | Annals of Internal Medicine: Clinical Cases

Tirzepatide is an effective medication that targets both glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, resulting in weight loss, improved glycemic control, and better cardiovascular and renal outcomes. Despite that, tirzepatide may have unfavorable consequences. Here, we present a woman in her 30s who was started on tirzepatide 3 months before admission. She had right upper quadrant pain and jaundice. Basic tests showed elevated liver enzymes and bilirubin levels. Her acute hepatitis panel and autoimmune work-up were negative. The abdominal ultrasound showed acute hepatitis with no gallbladder stones. We concluded that tirzepatide was most probably the culprit, with a RUCAM (Roussel Uclaf Causality Assessment Method) score of 7.

Perforation of the Sigmoid Portion in an Adult Patient With Dengue Fever: A Rare Case | Annals of Internal Medicine: Clinical Cases

Dengue fever can cause gastrointestinal complications, such as intestinal perforation. Pathogenesis is related to mucosal damage leading to ischemia. Diagnosis is through imaging that detects signs of perforation. Treatment is surgical repair of the lesion. A 54-year-old man presented with dengue fever and abdominal pain; abdominal ultrasound showed distension of intestinal loops with wall edema and interloop fluid. Chest radiography produced a finding of pneumoperitoneum. Perforation was suspected, requiring exploratory laparotomy and repair of the lesion. Intestinal perforation due to dengue fever is rare in the literature. It requires high clinical suspicion. Management requires exploratory laparotomy and repair.

A Case Report of Porphyria Complicated by PRES: A Trojan Horse Presenting as Dysmenorrhea | Annals of Internal Medicine: Clinical Cases

Acute intermittent porphyria (AIP) is a rare heme synthesis disorder often misdiagnosed due to nonspecific symptoms. Acute attacks feature severe abdominal pain, autonomic nervous system disturbances, and electrolyte imbalances. These can be complicated by posterior reversible encephalopathy syndrome (PRES), presenting with headaches, visual disturbances, confusion, and seizures. In patients with recurrent abdominal pain, autonomic symptoms (e.g., hypertension), or neurologic signs (e.g., seizures or PRES-like features), AIP should be considered. We present a case of a patient with abdominal pain who developed PRES and was later diagnosed with AIP, highlighting the importance of recognizing this condition in such clinical scenarios.

Full Tongue Necrosis in Giant Cell Arteritis: A Rare Case Presentation | Annals of Internal Medicine: Clinical Cases

Giant cell arteritis is a chronic disease of medium- and large-vessel vasculitis that most commonly affects vasculature of the head and neck. Delays in presentation or diagnosis can result in significant morbidity when progression of the disease results in total vessel occlusion.

Spontaneous Tumor Lysis Syndrome Secondary to Appendiceal Burkitt Lymphoma in an Older Man With Ascites | Annals of Internal Medicine: Clinical Cases

Malignant ascites is the accumulation of fluid-containing malignant cells in the peritoneal cavity, most often due to solid organ tumors. Rarely, abdominal lymphoma may also cause malignant ascites and masquerade as a colorectal tumor on imaging. Early diagnosis of aggressive lymphomas is important due to their potential for oncologic emergencies, including tumor lysis syndrome. Therefore, it is critical that lymphoma remain on the differential diagnosis for malignant ascites until it is ruled out. Here, we present a case of appendiceal Burkitt lymphoma presenting as rapid onset ascites and spontaneous tumor lysis syndrome.

A Case of Neurally Mediated Syncope and Sick Sinus Syndrome Associated With Lung Cancer | Annals of Internal Medicine: Clinical Cases

We describe a case of non–small cell lung cancer (NSCLC) associated with recurrent episodes of syncope. During the work-up for syncope, the patient was incidentally found to have a mass in the right upper lobe, which was later diagnosed as NSCLC. Positron emission tomography computed tomography showed metastatic lymphadenopathy of the supraclavicular and paratracheal nodes involving the cardiac branches of the vagus nerve. The patient no longer experienced syncope after starting immunochemotherapy. Considering the rapid and complete remission of syncope after the treatment of lung cancer and the location of metastatic lymphadenopathy, this condition might represent a location-dependent syndrome.

Black Esophagus and Diabetic Ketoacidosis | Annals of Internal Medicine: Clinical Cases

Black esophagus, also known as acute esophageal necrosis and Gurvits syndrome, is a rare medical condition characterized by a striking endoscopic appearance of diffuse black discoloration of the esophageal mucosa almost universally affecting the distal esophagus and extending proximally at various lengths. Risk factors include male sex, advanced age, cardiovascular and renal disease, diabetic ketoacidosis, thromboembolic disease, malignancy, and general debilitation. Endoscopic findings are classic and tissue histology is not required for diagnosis. Acute esophageal necrosis carries a poor prognosis, with up to one third of patients succumbing to underlying comorbid conditions.

Hypothalamic Hamartoma–Associated Central Precocious Puberty in a Young Boy: A Case Study | Annals of Internal Medicine: Clinical Cases

Hypothalamic hamartoma is a congenital malformation diagnosed via magnetic resonance imaging and histology, and it often is linked to central precocious puberty (CPP), gelastic seizures, and intellectual disabilities. This case report describes a 9-year-old boy with CPP attributable to hypothalamic hamartoma, a rare benign brain tumor. The boy exhibited advanced secondary sexual characteristics and rapid height increase. Elevated testosterone and a gonadotropin-releasing hormone stimulation test confirmed CPP, whereas magnetic resonance imaging was used to identify a nonenhancing lesion in the posterior hypothalamus. Monthly gonadotropin-releasing hormone analogue leuprorelin acetate injections effectively treated CPP. This case underscores the importance of early CPP diagnosis and treatment, especially given the rarity of hypothalamic hamartoma in boys.

Systemic Sclerosis With Central Nervous System Vasculitis: A Rare and Challenging Diagnosis and Review of the Literature | Annals of Internal Medicine: Clinical Cases

Systemic sclerosis (SSc) is a heterogeneous inflammatory disorder with significant impact on patients’ morbidity and mortality. Central nervous system (CNS) vasculitis is a rare presentation of connective tissue diseases, including SSc. We present the case of a young woman with subacute and progressively severe occipital headaches, impaired attention, low mood and anxiety, spatial and temporal disorientation, memory loss for recent events, and decreased hand dexterity. The diagnosis of CNS vasculitis secondary to SSc was achieved. We provide an overview of the differential diagnoses of this rare entity, which constitutes a challenging diagnosis, as well as a literature review.

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