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Orthostatic hypotension is a common cause of syncope, especially in the older adult population. While it is a commonly encountered issue as a cause of syncope, neurogenic orthostatic hypotension (nOH) is less common. Accurate diagnosis and management of neurogenic orthostatic hypotension is important especially when conservative measures fail. The condition of nOH is often seen in Parkinson disease or Parkinson plus syndromes. We present an unusual presentation of a patient with nOH who had no parkinsonian features but once started on norepinephrine agonism improved dramatically.

Scolex on the Brain: Intraventricular Neurocysticercosis | Annals of Internal Medicine: Clinical Cases

Neurocysticercosis is a parasitic infection caused by the pork tapeworm Taenia solium. Intraventricular neurocysticercosis develops when cysticerci become lodged in the ventricular outflow tract, which occurs in 10% to 20% of cases. Identification of a scolex within a cystic lesion is pathognomonic. Neurosurgical consultation is recommended to determine the appropriate operative course. When possible, removal of cysticerci using an endoscopic approach is recommended. We present a case of a 22-year-old woman from Honduras who was found to have obstructive hydrocephalus secondary to intraventricular neurocysticercosis and was treated successfully with shunt placement followed by medical therapy.

Successful Salvage Therapy With Infliximab in Carbamazepine-Induced Toxic Epidermal Necrolysis Complicated With Severe Acute Colitis | Annals of Internal Medicine: Clinical Cases

Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse reaction to drugs. We report a case of a severe acute colitis mimicking an ulcerative colitis concomitant with carbamazepine-induced TEN. Five days of intravenous methylprednisolone did not improve the digestive symptoms. Intensified infliximab treatment led to a complete clinical and endoscopic remission. No relapse occurred after 2 years of follow-up without maintenance treatment. Our case suggests that infliximab is a new therapeutic option in this rare extracutaneous manifestation of TEN.

Pulmonary Tumor Thrombotic Microangiopathy in a Patient With Dyspnea and Triple-Negative Breast Cancer | Annals of Internal Medicine: Clinical Cases

Pulmonary tumor thrombotic microangiopathy is a rare cause of pulmonary hypertension in patients with cancer, and pathology demonstrates tumor cells occluding the pulmonary vasculature. Clinical presentation ranges from subacute to acute signs of right ventricular failure. Treatment centers on antineoplastic therapies, but the use of pulmonary vasodilator therapies also has been reported.

Warfarin for Priapism With Primary Antiphospholipid Syndrome: From Culprit to Cure | Annals of Internal Medicine: Clinical Cases

Priapism is a hemodynamic disorder of penile circulation that results in persistent erection in the absence of sexual stimulation. It poses significant adverse effects on quality of life, and if left untreated, it can possibly lead to permanent erectile dysfunction. We present a case of a 38-year-old man with recurrent episodes of veno-occlusive priapism for 8 years, positive lupus anticoagulant antibody, and underlying antiphospholipid syndrome. Anticoagulant therapy was started, with considerable improvement in his symptoms. This report aims to highlight the atypical presentation of priapism, its pathophysiology, and the role of anticoagulation in patients with antiphospholipid syndrome.

Acute Kidney Injury From Acute Oxalate Nephropathy in Diabetic Ketoacidosis: A Case Report | Annals of Internal Medicine: Clinical Cases

Acute oxalate nephropathy is a rare cause of acute kidney injury. Most cases of hyperoxaluria and oxalate nephropathy have been due to increased oxalate absorption from enzymatic defects or malabsorption. Here, we describe a 60-year-old woman with long-standing diabetes who developed acute oxalate nephropathy during hospitalization due to renal hypoperfusion from diabetic ketoacidosis, nonsteroidal anti-inflammatory drug use, angiotensin-converting enzyme inhibitor use, and nephrotoxic antibiotics. The patient required hemodialysis briefly and improved with intravenous fluids with residual renal dysfunction on follow-up. Oxalate nephropathy causes severe renal failure, and it is an important differential diagnosis in patients with predisposing factors.

Sigmoid Volvulus | Annals of Internal Medicine: Clinical Cases

An 83-year-old woman who resided in a nursing home presented to the emergency department with abdominal pain and vomiting resulting in the diagnosis of sigmoid volvulus. She needed intermittent catheter reduction of the colonic air but no surgical intervention has been performed so far.

Cerebral Amyloid Angiopathy-Related Inflammation Presenting as Nontraumatic Subdural Hematoma | Annals of Internal Medicine: Clinical Cases

A 77-year-old woman presented with headache and confusion. Computed tomography of the head demonstrated an acute left falcine and tentorial subdural hemorrhage. Magnetic resonance imaging of the brain additionally showed sulcal hyperintensity on postcontrast T2-fluid attenuated inversion recovery images throughout the posterior left hemisphere with associated leptomeningeal enhancement. Magnetic resonance imaging 6 weeks later showed progression of these radiologic changes, prompting brain biopsy, which confirmed cerebral amyloid angiopathy-related inflammation (CAA-ri). To our knowledge, this is the first reported case of biopsy-proven CAA or CAA-ri presenting as acute nontraumatic subdural hemorrhage. This case suggests that CAA and CAA-ri may account for some nontraumatic subdural hemorrhages.

Stress Cardiomyopathy in Chronic Obstructive Pulmonary Disease and Asthma Exacerbations: A Narrative Literature Review | Annals of Internal Medicine: Clinical Cases

In patients with asthma or chronic obstructive pulmonary disease exacerbations, the association between use of β-adrenergic agonists and stress cardiomyopathy is becoming increasingly recognized. Considering the emergence of this association, we sought to consolidate information from the existing body of literature to derive observational trends. One case series and 8 case reports were reviewed. Sex, age, ethnicity, comorbid conditions, presenting symptoms, electrocardiogram findings, troponin values, amount and type of β-agonist used, and time to resolution of cardiomyopathy were examined.

Leptomeningeal Immunoglobulin G4–Related Disease: A Case Report | Annals of Internal Medicine: Clinical Cases

We present the case of an older man with history of rheumatoid arthritis, taking etanercept who developed focal neurologic deficits with imaging findings that raised concern for central nervous system neoplasia, as well as a nondiagnostic initial brain biopsy. Imaging showed left hemispheric leptomeningeal enhancement, as well as left frontal convexity rim-enhancing collections, suspicious for abscess. Empiric antibiotics did not improve the patient's condition, and a second central nervous system biopsy revealed a diagnosis of leptomeningeal immunoglobulin G4–related disease, a rare fibroinflammatory condition. Awareness of this condition, prompt diagnosis, and treatment are imperative to prevent irreversible organ damage, disability, and potentially death.

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Cardiology for the Internal Medicine Physician 2025: The Key Points Recordings Package

Expert clinician-educators will provide a focused update of the diagnostic, preventive, and therapeutic approaches to the patient at risk for, or with known, cardiovascular disease. Faculty will focus on the cardiovascular disease issues that internal medicine physicians most frequently encounter and will provide “key points” to update the audience and foster patient care.

Advances in Therapy Recordings Package

Expert clinician-educators will focus on pearls to help the practicing internal medicine physician maximize the utility of drug therapies. Newer medications and new uses for older medications will be covered. Current recommendations for “best therapy” for different diseases will also be covered. Common adverse effects of medications will be emphasized. Faculty will provide practical information on medications used for common medical problems, diabetes, and infectious diseases; safe use of medications in older patients; and drug interactions.

Perioperative Medicine 2025 Recordings Package

Expert clinician-educators will initially discuss preoperative anesthesia essentials, selection of validated cardiac risk assessment tools, venous thromboembolism prophylaxis in the most frequently performed surgeries, and antiplatelet agent management in patients with cardiac disease undergoing noncardiac surgery. Interspersed between these presentations will be clinical vignettes that complement the presentations and expand the topics discussed. The second phase of the course will be directed at the postoperative issues that face the medical consultants. These will include postoperative anesthesia issues; delirium and frailty assessment and treatments; postoperative cardiac complications including myocardial infarction, heart failure, and atrial fibrillation; and the appropriate use of perioperative anticoagulants. Each of these areas will be followed by clinical vignettes related to additional issues facing medical consultants in the postoperative period.

Diabetes for Internal Medicine Physicians 2025

Expert clinician-educators will discuss the diagnosis of prediabetes and diabetes, including atypical forms of diabetes in adults. Faculty will review the role of lifestyle interventions as well as appropriate indications and practical use of weight loss medications. The growing role of diabetes technology will be addressed and the risks and benefits of new insulin and noninsulin pharmacologic therapies will also be presented. The role of diabetes medications, cholesterol-lowering agents, and blood pressure control to reduce cardiometabolic risk will be thoroughly discussed.

Critical Care Medicine 2025 Recordings Package

An expert team of clinician-educators will provide a focused update on the diagnosis and management of common clinical issues encountered in the management of critically ill patients. Particular attention will be placed on new developments in the recognition of common critical care conditions, acute management of critical illness, and prevention of complications in the critically ill adult patient.

Advancing Nutrition in Medical Practice Recordings Package

Expert clinician-educators will provide physicians with evidence-based practical knowledge and skills to integrate nutrition into their practice, sharing updates based on the latest research. A range of practical topics will be covered, including culinary medicine, nutrition in chronic disease prevention and treatment, and the role of nutrition in hospital settings. Attendees will learn how to translate nutrition science into pragmatic applications, including cooking, dietary counseling, and providing patients with facts on dietary supplements. The course will promote interdisciplinary teamwork, including collaborative care with registered dieticians, and will approach nutrition through an inclusive lens that is respectful of diverse cultures and food traditions.

Continuous Glucose Monitoring Practice Cases

Continuous Glucose Monitoring (CGM) Practice Cases: (1 hour of CME) This educational activity is Part 2 of a two-part series focused on the use of continuous glucose monitoring (CGM) in the care of adult patients with type 2 diabetes mellitus. CGM provides patients with an awareness of rising or falling glucose levels and allows them to engage in more proactive management of their glucose. Once you are familiar with who is eligible for CGM, the available options, and interpretation of the data reports, test your knowledge with the cases that follow. If you are unfamiliar with CGM technology and interpretation of glucose trend data or need a refresher, please refer to Part 1 before continuing to these practice cases.

Continuous Glucose Monitoring

Continuous Glucose Monitoring (CGM): (2 hours of CME) This is Part 1 of a two-part series focused on the use of continuous glucose monitoring (CGM) in the care of adult patients with type 2 diabetes mellitus. CGM technology captures glucose trend data because glucose levels are continually measured. The resulting awareness of rising or falling glucose levels allows patients to engage in more proactive management of their glucose. CGM is a common tool for individuals with type 1 diabetes. Recent improvements in CGM technology and decreasing costs have led to increasing use of this technology in the management of type 2 diabetes. Internal medicine physicians and clinicians will receive practical tips for patient engagement and shared decision making. A systematic process for interpretation of CGM glycemic data is also presented.

Decision Making In Perioperative Medicine: Clinical Pearls, 2nd Edition

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