Search Results for: ""

We present a rare case of emphysematous pyelonephritis complicated by secondary emphysematous osteomyelitis, likely resulting from the hematogenous spread of Escherichia coli in a patient with multiple comorbid conditions. Early identification of computed tomography findings and prompt initiation of therapy resulted in a favorable outcome. This case underscores the importance of rapid diagnosis and intervention in patients with complex comorbid conditions, because early treatment can significantly improve outcomes.

Cardiac Spindle Cell Sarcoma Developed in a Patient With Extensive Cardiac History | Annals of Internal Medicine: Clinical Cases

A 76-year-old man with an extensive cardiac history presented with progressive dyspnea and was found to have a large cardiac sarcoma with positive MDM2. The mass occupied the left side of the heart, extended through the mitral valve orifice, and caused severe mitral valve disorders. Cardiac sarcomas are extremely rare, aggressive, and have a very poor prognosis. Owing to the rarity of the disease, treatment data are limited. However, sarcoma with MDM2 amplification may benefit from a combination of MDM2 inhibitor and immune checkpoint inhibitor. This report highlights the importance of a multimodality and multidisciplinary approach in clinical management of a rare primary cardiac tumor.

Syphilitic Hepatitis: An Atypical Presentation of an Uncommon Disease | Annals of Internal Medicine: Clinical Cases

Syphilitic hepatitis (SH) is a rare cause of liver disease and can be easily misdiagnosed. We present a case of an otherwise healthy young man hospitalized with marked acute liver injury without evidence of liver failure who, after an extensive work-up, was found to have SH. His diagnosis was confirmed by direct visualization of spirochetes on liver biopsy. This case highlights a unique presentation of SH and emphasizes the importance of taking a thorough sexual history.

Hyperbaric Oxygen Therapy for Scleroderma Wounds: A Report on Two Cases and Literature Review | Annals of Internal Medicine: Clinical Cases

Systemic sclerosis-associated wounds are often refractory to conventional wound care and pharmacotherapy. Hyperbaric oxygen (HBO2) therapy has a longstanding, yet infrequently documented, history of success healing wounds in patients with systemic sclerosis. Here, we present 2 cases of scleroderma-associated cutaneous wounds, unresponsive to standard treatments, successfully treated with HBO2. Additionally, we reviewed the current literature for articles that used HBO2 adjunctively with wound care in systemic sclerosis. These published studies showed an overall success rate of 81%.

Bevacizumab Results in Ongoing Resolution of Bleeding From Gastrointestinal Arteriovenous Malformations After Treatment Discontinuation | Annals of Internal Medicine: Clinical Cases

Angiodysplasias cause gastrointestinal (GI) bleeding in patients with end-stage renal disease (ESRD). We present a novel case of a 62-year-old man with a history of recurrent GI bleeding requiring multiple transfusions secondary to angiodysplasias in the stomach, duodenum, and small bowel. Therapeutic endoscopic treatments were ineffective and, in total, required 40 units of packed red blood cells in 1 year. He was treated with bevacizumab and achieved a dramatic response of being transfusion free after the first dose. While various treatments for bleeding angiodysplasias exist, refractory cases require innovative approaches. Our case illustrates the successful use of bevacizumab in managing transfusion-dependent anemia secondary to angiodysplasias in ESRD.

When Palpitations and Hand Weakness Point to the Aorta: An Atypical Case of Aortic Dissection | Annals of Internal Medicine: Clinical Cases

Aortic dissection (AD) is a life-threatening condition often presenting with varied symptoms, complicating early diagnosis. We present a case of a 58-year-old woman with untreated hypertension and a remote history of cardiac ablation who presented with persistent palpitations and transient left-hand weakness, but without chest or back pain. An incidental AD was identified during imaging for a suspected transient ischemic attack. Effective blood pressure management and prompt cardiothoracic intervention, with successful surgical repair, enabled favorable outcomes. This case underscores the diagnostic challenges posed by atypical AD presentations, highlighting the importance of maintaining high index of suspicion in at-risk population.

A Gastrointestinal Anomaly: Squamous Cell Carcinoma of the Tongue Reemerging as a Metastatic Colonic Polyp | Annals of Internal Medicine: Clinical Cases

Squamous cell carcinoma (SCC) metastasizes often to the liver, lungs, and lymph nodes. Gastrointestinal metastasis is not widely documented. A 75-year-old man with SCC of the tongue in remission status post chemoradiation presented with anemia and thrombocytopenia. Colonoscopy showed multiple polyps and a large ulcer over the transverse colon. The pathology department reported lymphovascular invasion and a positive p16 staining, an immunohistologic finding associated with high-risk human papillomavirus. Managing metastatic SCC of the colon poses a clinical challenge owing to its low occurrence and absence of treatment protocols. Further research into the mechanisms underlying SCC metastasis, particularly to the gastrointestinal tract, is warranted.

Gluten-Induced Hemoptysis: A Case Report of Lane–Hamilton Syndrome | Annals of Internal Medicine: Clinical Cases

Lane–Hamilton syndrome describes the co-occurrence of idiopathic pulmonary hemosiderosis and celiac disease. A 24-year-old man presented with fatigue and several weeks of scant hemoptysis. Investigations revealed profound anemia and left lower lobe ground-glass opacities on computed tomography scan of the chest. Transbronchial biopsies showed hemosiderin-laden macrophages. Ancillary investigations revealed elevated tissue transglutaminase level and celiac disease was confirmed on duodenal biopsy despite the absence of gastrointestinal symptoms. He was treated with a gluten-free diet and a tapering course of prednisone with excellent response. This case highlights that hemoptysis can be the only presenting symptom for Lane–Hamilton syndrome, warranting thorough investigations for celiac disease.

Resolution of Corticosteroid Refractory Checkpoint Inhibitor–Induced Pneumonitis With Tocilizumab and Mycophenolate Mofetil Therapy | Annals of Internal Medicine: Clinical Cases

A 69-year-old woman with metastatic esophageal cancer, undergoing treatment with FOLFOX (folinic acid, fluorouracil, and oxaliplatin), pembrolizumab, and trastuzumab, developed fever and hypoxemia following her fourth treatment cycle. Clinical presentation and radiographic findings confirmed a diagnosis of immune-related pneumonitis. Her condition deteriorated despite high-dose glucocorticoid therapy, necessitating intensive care unit management. Administration of tocilizumab and mycophenolate mofetil resulted in a dramatic improvement within 48 hours, leading to extubation and eventual hospital discharge. This case underscores the critical role of intensified immunosuppressive therapy for managing steroid-refractory pneumonitis and highlights tocilizumab as a potential agent to reduce mortality in this challenging clinical scenario.

Chronic Tenosynovitis Caused by Mycobacterium terrae: A Case Report Highlighting a Diagnostic Challenge | Annals of Internal Medicine: Clinical Cases

We report a rare case of chronic tenosynovitis of the upper extremity caused by Mycobacterium terrae, an infrequent and underdiagnosed pathogen. A 64-year-old man presented with persistent pain and swelling in the hand following a minor puncture wound. Despite multiple empirical treatments, including corticosteroids, antibiotics, and antifungals, the condition progressed over several months (Figure 1). Surgical intervention, histopathologic examination revealing granulomatous inflammation, and prolonged microbiological culture ultimately identified M terrae. Susceptibility-guided antimicrobial therapy resulted in complete clinical resolution. This case highlights the diagnostic complexity of M terrae infections and emphasizes the importance of considering atypical pathogens in cases of chronic tenosynovitis, especially when conventional therapies fail.

Previous See more results in Annals of Internal Medicine: Clinical Cases

Displaying 91 - 100 of 253 in ACP Store

Teaching Medicine Series - 7 Book Boxed Set

Teaching and Coaching in the Hospital

ACP POCUS 13: PEARLS - An Ultrasound Physical Examination

This module introduces the internal medicine physician to a method for examining patients with ultrasound based on well-recognized acoustic windows. When combined, these windows provide a framework for a multisystem ultrasound physical examination that integrates cardiac, pulmonary, and abdominal views. This resource is part of the Advanced Point-of-Care Ultrasound (POCUS) series and will prepare you to participate in the American College of Physicians (ACP) live Practical POCUS Skills for Internal Medicine Physicians course. Completion of assigned online learning activities is required prior to arrival at ACP training courses. Visit the website for further information about ACP’s POCUS Pathway, a comprehensive collection of live, hands-on training options.

ACP POCUS 12: Upper Extremity Musculoskeletal

Learn how to use POCUS to scan hand, wrist, and shoulder abnormalities that you may encounter in practice. This resource is part of the Advanced Point-of-Care Ultrasound (POCUS) series and will prepare you to participate in the American College of Physicians (ACP) live Practical POCUS Skills for Internal Medicine Physicians course. Completion of assigned online learning activities is required prior to arrival at ACP training courses. Visit the website for further information about ACP’s POCUS Pathway, a comprehensive collection of live, hands-on training options.

ACP POCUS 11: Lower Extremity Musculoskeletal

Learn how to use POCUS to scan for knee and ankle abnormalities that you may encounter in practice. This resource is part of the Advanced Point-of-Care Ultrasound (POCUS) series and will prepare you to participate in the American College of Physicians (ACP) live Practical POCUS Skills for Internal Medicine Physicians course. Completion of assigned online learning activities is required prior to arrival at ACP training courses. Visit the website for further information about ACP’s POCUS Pathway, a comprehensive collection of live, hands-on training options.

ACP POCUS 10: Gallbladder

Learn about the indications, anatomic landmarks, transducer considerations and techniques, and other POCUS skills associated with scanning the gallbladder and analyze examples of pathologic findings that you may encounter during such work. This resource is part of the Advanced Point-of-Care Ultrasound (POCUS) series and will prepare you to participate in the American College of Physicians (ACP) live Practical POCUS Skills for Internal Medicine Physicians course. Completion of assigned online learning activities is required prior to arrival at ACP training courses. Visit the website for further information about ACP’s POCUS Pathway, a comprehensive collection of live, hands-on training options.

ACP POCUS 9: Abdominal Aortic Aneurysm

Work through using POCUS to scan for abdominal aortic aneurysms and abnormalities that you may encounter during scanning. This resource is part of the Advanced Point-of-Care Ultrasound (POCUS) series and will prepare you to participate in the American College of Physicians (ACP) live Practical POCUS Skills for Internal Medicine Physicians course. Completion of assigned online learning activities is required prior to arrival at ACP training courses. Visit the website for further information about ACP’s POCUS Pathway, a comprehensive collection of live, hands-on training options.

ACP POCUS 8: Skin/Soft Tissue and Musculoskeletal

Learn the principles of ultrasound imaging of skin, soft tissue, and the musculoskeletal system. Review probe settings and techniques; echogenicity in ultrasound images; and abnormalities related to skin, soft tissue, and the musculoskeletal system. This resource is part of the Advanced Point-of-Care Ultrasound (POCUS) series and will prepare you to participate in the American College of Physicians (ACP) live Practical POCUS Skills for Internal Medicine Physicians course. Completion of assigned online learning activities is required prior to arrival at ACP training courses. Visit the website for further information about ACP’s POCUS Pathway, a comprehensive collection of live, hands-on training options.

Soft Shell Jacket - Unisex

Soft Shell Women Jacket

Previous See more results in ACP Store