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Plasmablastic lymphoma is a rare, highly aggressive subtype of diffuse large B-cell lymphoma and is more prevalent in the immunocompromised patient population. This is a case of plasmablastic lymphoma in a 53-year-old man with HIV, presenting with an oral mass and severe hypercalcemia.

Hyperostosis Frontalis Interna | Annals of Internal Medicine: Clinical Cases

A 73-year-old woman with alcohol use disorder and breast cancer who presented with 2 months of progressive lethargy and generalized weakness initially was suspected of having acute metabolic encephalopathy attributable to alcohol-related liver disease. She ultimately was diagnosed with hyperostosis frontalis interna, a benign condition potentially contributing to her neurologic symptoms. This case underscores the importance of the recognition of hyperostosis frontalis interna for patients who are postmenopausal presenting with neuropsychologic symptoms and skull abnormalities to prevent misdiagnosis and unnecessary interventions.

Autoimmune Ascites, a Manifestation of an Overlap Syndrome: Diffuse Systemic Sclerosis and Systemic Lupus Erythematosus | Annals of Internal Medicine: Clinical Cases

We report a rare case of autoimmune ascites in a 72-year-old woman presenting an overlap syndrome involving diffuse systemic sclerosis and systemic lupus erythematosus. The diagnostic complexity of overlapping systemic autoimmune diseases and challenges in identifying the predominant disease are highlighted. This case emphasizes the necessity of a comprehensive evaluation in unraveling complex overlap syndromes in autoimmune conditions.

Superior Vena Cava Syndrome in the Immediate Postoperative Period After Biatrial Heart Transplantation | Annals of Internal Medicine: Clinical Cases

Superior vena cava syndrome represents a medical condition characterized by a constellation of signs and symptoms, the most feared complication being cerebral edema. To our knowledge, there are no reports in the literature of vena cava syndrome in patients with bicaval heart transplants with successful resolution through endovascular intervention and its outcomes. We present the case of a 59-year-old woman with Ebstein anomaly in refractory heart failure who had a biatrial heart transplant and presented with superior vena cava syndrome after surgery. The patient underwent interventional treatment, which was successful and remarkably free of complications, and was discharged from the hospital.

A Novel Case of Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Secondary to Acalabrutinib | Annals of Internal Medicine: Clinical Cases

Here we describe an unusual case of a patient with chronic lymphocytic leukemia who developed drug reaction with eosinophilia and systemic symptoms from the Bruton kinase inhibitor acalabrutinib and propose a mechanism by which this class of medications may increase the potential for developing such reactions in this patient population. Drug reaction with eosinophilia and systemic symptoms has not been described previously in association with Bruton kinase inhibitors, which are known to target B cells.

Arterial Thromboembolism in a Patient With Cancer With Unclear Etiology | Annals of Internal Medicine: Clinical Cases

A 57-year-old man with chronic lymphocytic leukemia presented with acute ischemia of the left lower extremity. The patient was taken for emergent surgical thrombectomy of the common femoral artery and the thrombus was submitted for pathologic evaluation, which showed chronic lymphocytic leukemia lymphocytes commensurate in the thrombus. The patient had no classic risk factors for atherosclerosis. Although he does have active malignancy and is undergoing treatment, his current regimen has a low risk for thrombotic events. Furthermore, the histopathology indicates possible involvement of lymphocytes. This case highlights the need for more understanding of the mechanism of cancer-associated thromboembolic events.

Superior Vena Cava Syndrome After Orthotopic Heart Transplantation | Annals of Internal Medicine: Clinical Cases

Superior vena cava syndrome is a constellation of clinical signs and symptoms resulting from the obstruction of blood flow through the superior vena cava. Although it rarely occurs in the setting of orthotopic heart transplantation, here we report a case that developed in the early postoperative setting. Our goal is to raise awareness of this entity, given the associated high fatality rate and potential challenges of timely recognition in the setting of sedation and mechanical ventilation.

Nicoladoni-Branham Sign in the Coronaries: Fistula Closure Leads to Immediate Relief | Annals of Internal Medicine: Clinical Cases

We describe the first reported case, to our knowledge, of Nicoladoni-Branham sign in a patient with a large right coronary artery to superior vena cava fistula presenting with high-output heart failure. Percutaneous closure of the fistula resulted in immediate symptomatic relief and resolution of sinus tachycardia. It is important to recognize this physiologic mechanism not only to resolve high-output heart failure but also to relieve patients from years of unrelenting dyspnea, palpitations, and discomfort.

Bloodstream Infection Caused by Williamsia spp., a Frequently Misidentified Emerging Pathogen | Annals of Internal Medicine: Clinical Cases

Williamsia species have been isolated from many disparate environmental sources but only 4 cases of human infection have been reported previously. We now report the first case of W spongiae bacteremia, illustrating the difficulty in recognizing this genus of an emerging health care–associated pathogen.

Clostridium subterminale Empyema in a Patient With Pulmonary Embolism | Annals of Internal Medicine: Clinical Cases

Clostridium subterminale is rarely a source of infection in humans, with only a handful of cases reported over the last several decades. Secondary to the low virulence of this specific species, there is a paucity of literature on pulmonary infections caused by this bacterium. We present a case of a patient with C subterminale empyema with a recent history of submassive pulmonary embolism associated with pulmonary infarction.

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Generative AI for Physicians

Designed for physicians, this brief, self-paced primer covers generative artificial intelligence, including its capabilities, important terms, and use cases of gen AI tools in medicine. Learn about large language models and their impact on health care and get started with practice activities.

Primary Care Psychiatry: Practical Skills for Internal Medicine Physicians Recordings Package

Expert clinician-educators will provide a practical, evidence-based update for internal medicine physicians on approaches to interviewing patients with the goal of recognizing, diagnosing, treating, and/or referring patients with commonly encountered mental health disorders. Faculty with training in both internal medicine and psychiatry will emphasize the importance of a patient-centered approach, motivational interviewing, and quick cognitive behavioral techniques that can be quickly used in medical settings. A practical overview of psychopharmacology strategies in the general medical setting will also be discussed. Faculty will focus on psychiatric diagnoses that are prevalent in general medical practice, including major depressive disorder, anxiety disorders, trauma-related disorders, substance use disorders, chronic pain, and bipolar mood disorders, with a goal of improving recognition, confidence in management, and effectiveness of referral.

Hospital Medicine: Success in a Complex Environment Recordings Package

Highly experienced clinician faculty will provide essential updates on key medical issues, take you through the challenges of common and complex clinical conundrums, and address how to effectively improve the value of care provided to patients. The needs of the patient, as well as the impact on the hospital and hospitalist, will be considered in this highly practical, case-based curriculum.

Geriatrics and Palliative Medicine for Internal Medicine Physicians Recordings Package

Highly knowledgeable clinician educators will focus on practical, evidence-based strategies that the internal medicine physician can use across care settings to better identify and treat serious and chronic conditions common to older populations, such as cognitive impairment; function assessment, frailty, and falls; depression and anxiety; and hazards of hospitalization. Faculty will discuss primary palliative care approaches, including strategies for clinical decision making and deprescribing in the setting of complex medical conditions; providing a systematic approach to pain and symptom management; applying principles of prognostication to those with serious illness and advanced age; and serious illness communication skills.

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