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Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder characterized by the development of visceral arteriovenous malformations (AVMs), which result in recurrent episodes of epistaxis, mucosal bleeding, and iron deficiency anemia. Hepatic AVMs, when untreated, may lead to high-output cardiac failure, pulmonary hypertension, and hepatic cirrhosis. While not routinely done, a shunt run performed during right heart catheterization (RHC) can provide valuable physiologic data to guide the diagnostic evaluation of patients in complex cases of suspected pulmonary hypertension. We present a case in which an abnormal shunt run during RHC revealed intrahepatic shunting and ultimately led to the diagnosis of HHT.

Enterococcus faecalis Meningitis and Ventriculitis: Thinking Outside the Gut | Annals of Internal Medicine: Clinical Cases

Enterococcus faecalis, classified as a group D streptococcus, is a gram-positive, commensal organism, living in our gastrointestinal tract. However, the presence of certain genetic factors assists the bacterium to gain pathogenicity. Central nervous system infection by E faecalis is rare, usually associated with trauma, recent neurosurgical procedures, and presence of intracranial devices. Here, we present a case of meningitis and ventriculitis by E faecalis in a man with a history of cranioplasty and dural graft placement, who was subsequently found to have involvement of his intracardiac (Watchman) device.

Echoes of Liver in the Lung: A Diagnostic Zebra in Thoracic Oncology | Annals of Internal Medicine: Clinical Cases

Hepatoid adenocarcinoma (HAC) is a rare and aggressive subtype of extrahepatic adenocarcinoma that mimics hepatocellular carcinoma. Pulmonary HAC is exceptionally uncommon and often presents diagnostic and therapeutic challenges. We describe a 65-year-old woman with chronic obstructive pulmonary disease and hypertension who presented with progressive dyspnea. Imaging revealed right lung masses and mediastinal lymphadenopathy. Biopsy confirmed hepatoid non–small cell lung cancer. Molecular testing revealed no actionable mutations. The patient declined systemic therapy. This case highlights the complexity of managing pulmonary HAC, the role of shared decision making, and the urgent need for more evidence-based treatment approaches.

Fournier Gangrene in a Patient Receiving Ixekizumab Therapy | Annals of Internal Medicine: Clinical Cases

We report a case of a 42-year-old man who developed Fournier gangrene while undergoing treatment of psoriatic arthritis with the interleukin-17 inhibitor ixekizumab (Taltz). There is growing use of biologics such as ixekizumab for symptom relief and control of various autoimmune diseases, including psoriatic arthritis. There is known increased risk for infection, both systemic and cutaneous, with the use of similar biologics. Specifically, ixekizumab has been reported to be associated with upper respiratory infections. However, there is little data on severe cutaneous infections. To our knowledge, we report the first case of Fournier gangrene as a potential adverse effect of ixekizumab use.

Immunoglobulin G4-Related Disease Masquerading as Crohn Disease, Managed by Intestinal Ultrasound: A Case Report | Annals of Internal Medicine: Clinical Cases

We present the case of a 36-year-old man initially diagnosed with Crohn disease who was nonresponsive to numerous advanced therapies. Further evaluation revealed diffuse lymphadenopathy, severe enterocolitis, and significantly elevated immunoglobulin G4 levels. Staining of colonic biopsies confirmed IgG4-related enterocolitis. Treatment with rituximab therapy and dose adjustment guided by clinical symptoms, stool calprotectin, and intestinal ultrasound resulted in symptomatic, endoscopic, histologic, and transmural healing.

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

Methemoglobinemia-Induced Cardiac Dysfunction in a Pediatric Patient | Annals of Internal Medicine: Clinical Cases

Methemoglobinemia is a rare congenital or acquired cause of functional anemia resulting from oxidation of hemoglobin. Prompt recognition and treatment are critical to prevent tissue hypoxia and end-organ injury. While other complications are well described, cardiac dysfunction is rarely reported—especially in children. We present what, to our knowledge, is the first known case of methemoglobinemia-induced transient cardiac dysfunction—or “myocardial stunning—in a pediatric patient. This case underscores the importance of maintaining a high index of suspicion and assessing cardiac involvement in such patients. Early intervention can lead to full recovery and prevent long-term sequelae, even in the presence of multiorgan failure.

Legionella longbeachae Pneumonia Detected by Microbial Cell-Free DNA Sequencing | Annals of Internal Medicine: Clinical Cases

We report a case of severe community-acquired pneumonia caused by Legionella longbeachae, a rare soil-associated organism undetected by conventional testing. The patient initially required intubation and extracorporeal membrane oxygenation. Subsequent microbial cell-free DNA sequencing identified L longbeachae and enabled precise therapy, contributing to clinical improvement. For clinicians, L longbeachae should be in the differential diagnosis as a rare cause for severe pneumonia, in patients with soil and compost exposure but negative standard testing. In patients with high suspicion, advanced testing such as microbial cell-free DNA sequencing can help solidify the diagnosis.

Disseminated Blastomycosis as an Infiltrating Spinal Mass Mimicking Malignancy | Annals of Internal Medicine: Clinical Cases

This is a case of a young immunocompetent man with upper back pain and imaging of an infiltrative vertebral mass diagnosed with disseminated blastomycosis after a surgical pathology and cultures who was treated successfully with antifungal therapy. It highlights the diagnostic challenges of blastomycosis because of limited clinician familiarity, even in endemic regions, low clinical suspicion as the result of atypical presentations, imaging overlap with malignancy, and infection in healthy individuals without significant exposure history. The report emphasizes the importance of considering fungal infections in the differential diagnosis of infiltrative skeletal lesions, particularly in endemic regions where blastomycosis remains underdiagnosed and underreported.

Uncovering Dysphagia Lusoria: A Case of Late-Onset Symptoms in the 60s Following Percutaneous Coronary Intervention | Annals of Internal Medicine: Clinical Cases

Normally, the right subclavian artery arises from the brachiocephalic trunk and courses anterior to the esophagus. In arteria lusoria, it originates as the last branch of the aortic arch and passes posterior to the esophagus, creating a retroesophageal path that may compress the esophagus and cause dysphagia lusoria. It is a rare congenital vascular anomaly occurring in approximately 0.5% to 2% of the population. We describe a 61-year-old man who developed dysphagia 2 days after percutaneous coronary intervention, with imaging revealing aberrant right subclavian artery (ARSA) consistent with dysphagia lusoria despite no procedural complications.

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