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We report a rare case of a 22-year-old woman with transfusion-dependent beta-thalassemia major who presented with primary amenorrhea. Work-up revealed dual etiologies: hypogonadotropic hypogonadism attributable to pituitary iron overload and müllerian agenesis consistent with Mayer–Rokitansky–Küster–Hauser syndrome. Magnetic resonance imaging demonstrated iron deposition in the anterior pituitary and hypoplastic müllerian structures. This case highlights a rare but possible coexistence of iron-induced hypogonadotropic hypogonadism and Mayer–Rokitansky–Küster–Hauser syndrome in patients with thalassemia major. Although each condition may occur independently, their co-occurrence is infrequently reported. Early recognition of overlapping pathologies is critical for timely diagnosis, management, and counseling.

Mycoplasma pneumoniae–Induced Rash and Mucositis in a 21-Year-Old Man | Annals of Internal Medicine: Clinical Cases

We report a case of Mycoplasma pneumoniae–induced rash and mucositis (MIRM) in a 21-year-old man. After 5 days of nonproductive cough, our patient developed painful vesicular lesions of the oral mucosa. Laboratory evaluation revealed isolated M pneumoniae infection, with negative results for other infectious and autoimmune etiologies. The patient was treated with azithromycin and corticosteroids, leading to rapid improvement of his mucocutaneous lesions and return to baseline function. This case provides an overview of MIRM presentation, differential diagnosis, and management with combined antibiotic and immunomodulatory therapy.

Visual Restoration in Rare Ocular Lyme Borreliosis Using Adjunctive Steroid and Antibiotic Therapy | Annals of Internal Medicine: Clinical Cases

Ocular Lyme borreliosis is the term used to describe a rare complication of late-stage Lyme disease, whereby one might experience ophthalmic disturbances secondary to Lyme infection. Whereas standard treatment of Lyme disease with any neurologic manifestation is either oral doxycycline or intravenous (IV) ceftriaxone (for severe cases), adjunctive steroid treatment is either not advised or of uncertain benefit. We present a case of ocular Lyme borreliosis that was successfully treated with a combination of high-dose steroids in conjunction with IV antibiotics.

A Case of Severe Bradycardia and Hypotension Due to Hydroxychloroquine Cardiotoxicity | Annals of Internal Medicine: Clinical Cases

We describe a case of an 84-year-old woman who had been on hydroxychloroquine (HCQ) for several years for cutaneous lupus. She initially presented with several months of progressive weakness and elevated cardiac biomarkers and later developed severe bradycardia with ventricular escape rhythms. She was found to have left ventricular hypertrophy with diastolic dysfunction and reduced global longitudinal strain. We discuss the differential diagnosis for her presentation and the test that confirmed the diagnosis of HCQ-induced cardiomyopathy, a rare side effect of prolonged HCQ use.

Acute Liver Failure Secondary to Herpes Simplex Virus Hepatitis Following Gynecologic Surgery | Annals of Internal Medicine: Clinical Cases

Herpes simplex virus (HSV) hepatitis is a lethal cause of acute liver failure (ALF). This is likely due to its nonspecific clinical presentation delaying diagnosis. There are a handful of case reports describing HSV hepatitis in pregnancy, but there are no published cases associating HSV hepatitis with gynecologic surgery (GS). We report HSV-associated ALF progressing to death in 2 young patients who are immunocompetent without significant medical comorbid conditions. Both patients had GS preceding their liver injury. This highlights a possible predisposition to HSV hepatitis following GS and suggests heightened clinical suspicion and consideration of empirical acyclovir in patients presenting with ALF following GS.

Acute Amiodarone-Induced Pulmonary Toxicity: Presentation and Management | Annals of Internal Medicine: Clinical Cases

This case report describes a 68-year-old man who developed acute hypoxic respiratory failure 2 weeks after initiation of amiodarone and mexiletine treatment for ventricular arrhythmia. The case underscores the diagnostic challenge of differentiating pulmonary edema from acute amiodarone-induced pulmonary toxicity and the importance of clinical context when interpreting imaging findings. Management involved immediate discontinuation of amiodarone and initiation of high-dose intravenous steroids followed by a prolonged oral taper, resulting in rapid clinical improvement. This case further illustrates the potential for oral amiodarone to cause multiorgan toxicity.

Mixed Cold and Warm Autoimmune Hemolytic Anemia Following Babesiosis in an Immunocompromised Patient | Annals of Internal Medicine: Clinical Cases

Babesiosis is a tick-borne infection diagnosed by characteristic intracellular inclusions on peripheral blood smears. While nonimmune hemolytic anemia is a known complication of babesiosis infection, autoimmune hemolytic anemia caused by babesiosis infection is much more rare. Here, we describe a case of cold agglutinin syndrome in a patient with babesiosis infection who was also on ofatumumab therapy for multiple sclerosis. The patient continued to have evidence of hemolysis after appropriate antimicrobial therapy and after clearance of peripheral blood smears. This case illustrates a need for further research into CAS associated with babesiosis infection.

Rare Cutaneous Metastasis of Endometrial Carcinoma: A Sister Mary Joseph Nodule | Annals of Internal Medicine: Clinical Cases

Sister Mary Joseph nodules are cutaneous evidence of umbilical metastasis from an abdominal or pelvic primary neoplasm. They typically present as a firm, tender, irregular mass with evidence of serous or purulent discharge ranging in size from 0.5 cm all the way up 10 cm. This case describes a rare presentation of Stage IV B, Grade 2 endometrioid carcinoma of the endometrium as a Sister Mary Joseph nodule in an 82-year-old nulliparous woman. While the pathophysiology of these lesions is poorly understood, early recognition of these nodules aids in decreasing time to diagnostic work-up and treatment.

Hemopericardium From Ventricular Rupture: A Rare but Predictable Complication of Subacute Infarction | Annals of Internal Medicine: Clinical Cases

Left ventricular rupture is a rare but catastrophic complication of myocardial infarction, often associated with delayed or atypical presentations. Here, we report an 89-year-old man with prior coronary artery bypass grafting presenting with chest pain and diagnosed with a non–ST-segment elevation myocardial infarction due to small-vessel occlusion. He presented 3 days later with dyspnea and was found on echocardiography to have posterior free wall rupture with hemopericardium causing cardiovascular collapse. This case highlights the importance of maintaining suspicion for postinfarction complications to obtain early echocardiographic evaluation in patients with recent ischemic events and unexplained dyspnea.

A Rare Case of Ectopic ACTH Syndrome Most Likely Resulting From Metastatic Prostate Cancer | Annals of Internal Medicine: Clinical Cases

Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare condition accounting for approximately 10% of all Cushing syndrome cases. Herein, we present a rare case of ectopic ACTH syndrome most likely resulting from metastatic prostate cancer. A 40-year-old man with metastatic castration-resistant prostate adenocarcinoma presented with worsening left lower extremity edema. He received work-up for Cushing syndrome given his persistent hypokalemia and was diagnosed with ectopic ACTH syndrome. He was started on treatment with ketoconazole. Unfortunately, after discharge from the hospital, his clinical condition continued to deteriorate, and he elected to home hospice where he died.

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