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We present a rare case of isolated perianal Crohn disease (iPCD) with perineal involvement in a 28-year-old woman who remained free of luminal gastrointestinal symptoms for more than 10 years. The diagnosis was significantly delayed due to clinical overlap with hidradenitis suppurativa and pilonidal disease. The patient had multiple unsuccessful treatments, including antibiotics, immunosuppressants, and biological agents. Complete remission was ultimately achieved with combination therapy using infliximab and azathioprine. This case underscores the importance of early recognition, accurate differentiation from mimicking conditions, and a multidisciplinary approach to managing iPCD.

A Case of Nonfreezing Cold Injury—A Nonoccupational Case Seen in an Occupational Clinic | Annals of Internal Medicine: Clinical Cases

Work is a social determinant of health with far-reaching impacts, such as economic security, hazard exposure, and access to health care. This is a case report of a National Aeronautics and Space Administration (NASA) employee who sustained a nonfreezing cold injury in a nonoccupational/nonwork-related setting but sought and received care at her place of work, a NASA Health Unit. This case presents an infrequent diagnosis and highlights the value of an on-site health care facility in management of conditions common and rare. An on-site health unit can play an important role in offering timely evaluations and increasing health care access during working hours.

Unveiling the Link: Exploring the Association Between Cancer and Leukocyte Chemotactic Factor 2 (ALECT2) Amyloidosis | Annals of Internal Medicine: Clinical Cases

We present a case of a 53-year-old Hispanic man with mantle cell lymphoma who developed progressive decline in estimated glomerular filtration rate despite no previous kidney disease or predisposing conditions. Findings of a renal biopsy revealed leukocyte chemotactic factor 2 (ALECT2) amyloidosis. Remarkably, after treatment of his lymphoma, the patient's estimated glomerular filtration rate normalized. Given the correlation between the patient's cancer and the improvement in kidney function after treatment, we hypothesize that his lymphoma may have acted as a trigger for ALECT2 amyloidosis through 1 or more potential mechanisms, including dysregulated Wnt/β-catenin signaling, tumor-related inflammatory pathways, or a second hit on an underlying genetic predisposition.

Clinical Challenges in Tension Gastrothorax: A Tale of Two Cases and Review of the Literature | Annals of Internal Medicine: Clinical Cases

Tension gastrothorax is a life-threatening condition characterized by herniation of the stomach into the thoracic cavity, leading to a mediastinal shift, causing obstructive shock. It can be frequently misdiagnosed as tension pneumothorax due to similar presentations. Prompt recognition is crucial to reduce associated morbidity and mortality. We present 2 adult cases of acute hypoxemic respiratory failure that progressed to tension gastrothorax with the use of noninvasive positive-pressure ventilation. Emergent management involves decompression strategies with nasogastric tube placement, but definitive management requires surgical correction. These cases underscore the importance of early diagnosis and appropriate management to improve patient outcomes.

Atypical Skull Base Osteomyelitis From Streptococcus parasanguinis | Annals of Internal Medicine: Clinical Cases

Atypical skull base osteomyelitis is a rare condition that can lead to critical complications if left unrecognized. It is difficult to diagnose owing to nonspecific clinical presentations and delayed imaging findings. It typically occurs from nonotologic infections that affect the clivus and requires at least 6 weeks of antibiotics. This case describes a patient presenting with an acute left-sided headache who was eventually diagnosed with atypical skull base osteomyelitis caused by Streptococcus parasanguinis from a sinus infection.

Aortitis in Extracranial Giant Cell Arteritis: Do Not Lose Sight of the Patient | Annals of Internal Medicine: Clinical Cases

Giant cell arteritis is the most common systemic vasculitis. This case highlights aortic dissection as a potentially life-threatening complication of giant cell arteritis, in most instances occurring as very late event years or even decades after initial diagnosis.

Correction: Chronic Pulmonary Silicone Embolism Syndrome Following Saline Breast Implants | Annals of Internal Medicine: Clinical Cases

Correction: Diabetic Striatopathy: A Rare Case Report of Chorea, Hyperglycemia, Basal Ganglia (C-H-BG) Syndrome | Annals of Internal Medicine: Clinical Cases

Silica Nephrolithiasis From Commonly Used Over-the-Counter Vitamins and Supplements: A Case Report | Annals of Internal Medicine: Clinical Cases

Silica and calcium carbonate are very rare constituents of renal calculi, historically associated with chronic ingestion of magnesium trisilicate. We present a case of silica and calcium carbonate first-time nephrolithiasis in a 47-year-old man taking multiple over-the-counter vitamins and supplements that contained silica and calcium carbonate as excipients, while also fasting during Ramadan. The patient was counseled to discontinue all supplements containing silicon dioxide with no recurrence since. This case emphasizes the importance of stone analysis, the need for heightened scrutiny in supplement use, and the significance of considering patients’ cultural and religious practices that can influence their health.

A Case of Familial Hypercholesterolemia and Cerebrotendinous Xanthomatosis With Multiple Giant Xanthomas | Annals of Internal Medicine: Clinical Cases

A 56-year-old woman was referred to our hospital for evaluation of multiple infectious giant xanthomas on her upper and lower limbs. She was initially diagnosed with heterozygous familial hypercholesterolemia with a proprotein convertase subtilisin/kexin type 9 (PCSK9) mutation and was administered a PCSK9 inhibitor. However, the infectious state of the giant xanthomas did not improve, despite good control of the patient's low-density lipoprotein cholesterol levels. After further investigation, the patient was diagnosed with cerebrotendinous xanthomatosis. After initiation of treatment with chenodeoxycholic acid in addition to a PCSK9 inhibitor, the xanthoma ulcer gradually improved and eventually healed.

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