Prutha Pathak, Siddharth Patel, Brendan Gaylord, Punuru J. Reddy
Fatigue, fever, localized soreness, urticaria, and rash are common adverse reactions of COVID-19 vaccines. However, the occurrence of serious autoimmune reactions is quite rare. Cutaneous small-vessel vasculitis is an autoimmune disorder that manifests with palpable purpura and petechiae involving extremities. It results from neutrophilic inflammation within and around dermal vessels and is usually self-limited. We report a 55-year-old woman presenting with a rash 48 hours after receiving the third (Moderna) COVID-19 vaccine dose. Blood investigations and a skin punch biopsy confirmed the diagnosis of COVID-19 vaccine–induced cutaneous small-vessel vasculitis. The patient ultimately improved after inpatient treatment with systemic steroids.
{"title":"Vasculitis After a Vaccine: Rare Adverse Reaction Following a COVID-19 Vaccine","authors":"Prutha Pathak, Siddharth Patel, Brendan Gaylord, Punuru J. Reddy","doi":"10.7326/aimcc.2022.1043","DOIUrl":"https://doi.org/10.7326/aimcc.2022.1043","url":null,"abstract":"Fatigue, fever, localized soreness, urticaria, and rash are common adverse reactions of COVID-19 vaccines. However, the occurrence of serious autoimmune reactions is quite rare. Cutaneous small-vessel vasculitis is an autoimmune disorder that manifests with palpable purpura and petechiae involving extremities. It results from neutrophilic inflammation within and around dermal vessels and is usually self-limited. We report a 55-year-old woman presenting with a rash 48 hours after receiving the third (Moderna) COVID-19 vaccine dose. Blood investigations and a skin punch biopsy confirmed the diagnosis of COVID-19 vaccine–induced cutaneous small-vessel vasculitis. The patient ultimately improved after inpatient treatment with systemic steroids.","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135809932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case of systemic lupus erythematosus with IgA nephropathy and acute progressive glomerulonephritis. Renal function failed to recover after the administration of glucocorticoid and cyclophosphamide pulse therapy, which shows that systemic lupus erythematosus and IgA nephropathy may coexist at the same time.
{"title":"A Case Report of Systemic Lupus Erythematosus With IgA Nephropathy and Crescentic Nephritis","authors":"Zhifeng Jiang, Aiqiao Feng","doi":"10.7326/aimcc.2023.0157","DOIUrl":"https://doi.org/10.7326/aimcc.2023.0157","url":null,"abstract":"We report a case of systemic lupus erythematosus with IgA nephropathy and acute progressive glomerulonephritis. Renal function failed to recover after the administration of glucocorticoid and cyclophosphamide pulse therapy, which shows that systemic lupus erythematosus and IgA nephropathy may coexist at the same time.","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135811800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Walter Yaw Agyeman, Inemesit Akpan, Kwasi Opare-Addo, Saheed Soleye, Alfred Solomon
{"title":"Euglycemic Diabetic Ketoacidosis in a Patient Post Cardiac Surgery Receiving Continuous Renal-Replacement Therapy","authors":"Walter Yaw Agyeman, Inemesit Akpan, Kwasi Opare-Addo, Saheed Soleye, Alfred Solomon","doi":"10.7326/aimcc.2023.0663","DOIUrl":"https://doi.org/10.7326/aimcc.2023.0663","url":null,"abstract":"","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134931115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alastair K. Williams, Ryan J. Stubbins, Eric McGinnis, John A. Maguire, Persia Pourshahnazari, Claudie Roy, Luke Y.C. Chen, Thomas J. Nevill
Germline pathogenic mutations in the GATA2 gene, a critical transcription factor in hematopoietic and neurologic development, are known to cause various syndromes characterized by both hematopoietic (for example, monocytopenia, myelodysplastic syndrome) and extra-hematopoietic (for example, lymphedema, atypical and mycobacterial infections) manifestations. Neurologic features of this disease need to be better understood. We describe 2 patients with germline GATA2 deficiency who developed a progressive neurologic illness characterized by upper motor neuron weakness, bulbar and cerebellar dysfunction, pronounced white matter magnetic resonance imaging abnormalities, and noninfectious leukoencephalopathy with cerebellar degeneration. These neurologic findings may be a novel extra-hematopoietic manifestation of germline GATA2 deficiency.
{"title":"Neurologic Manifestations of Germline <i>GATA2</i> Deficiency: A Report of Two Cases","authors":"Alastair K. Williams, Ryan J. Stubbins, Eric McGinnis, John A. Maguire, Persia Pourshahnazari, Claudie Roy, Luke Y.C. Chen, Thomas J. Nevill","doi":"10.7326/aimcc.2022.1087","DOIUrl":"https://doi.org/10.7326/aimcc.2022.1087","url":null,"abstract":"Germline pathogenic mutations in the GATA2 gene, a critical transcription factor in hematopoietic and neurologic development, are known to cause various syndromes characterized by both hematopoietic (for example, monocytopenia, myelodysplastic syndrome) and extra-hematopoietic (for example, lymphedema, atypical and mycobacterial infections) manifestations. Neurologic features of this disease need to be better understood. We describe 2 patients with germline GATA2 deficiency who developed a progressive neurologic illness characterized by upper motor neuron weakness, bulbar and cerebellar dysfunction, pronounced white matter magnetic resonance imaging abnormalities, and noninfectious leukoencephalopathy with cerebellar degeneration. These neurologic findings may be a novel extra-hematopoietic manifestation of germline GATA2 deficiency.","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135811027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The most common lesions in the anterior mediastinum are thymomas, lymphomas, teratomas, and thyroid masses. Squamous cell carcinoma of anterior mediastinum is most commonly due to thymic carcinoma. We present an unusual case of a patient presenting with anterior mediastinal mass that was later found to be biopsy-proven invasive squamous cell carcinoma of unknown primary site based on the available imaging studies. We also review the broad differential diagnoses, clinical presentation, and diagnostic work-up of anterior mediastinal mass, especially the one with no clear primary site.
{"title":"Invasive Squamous Cell Carcinoma of Anterior Mediastinum of Unknown Primary Site","authors":"Bibek Koirala, Min Zhang, Ali Akalin","doi":"10.7326/aimcc.2023.0111","DOIUrl":"https://doi.org/10.7326/aimcc.2023.0111","url":null,"abstract":"The most common lesions in the anterior mediastinum are thymomas, lymphomas, teratomas, and thyroid masses. Squamous cell carcinoma of anterior mediastinum is most commonly due to thymic carcinoma. We present an unusual case of a patient presenting with anterior mediastinal mass that was later found to be biopsy-proven invasive squamous cell carcinoma of unknown primary site based on the available imaging studies. We also review the broad differential diagnoses, clinical presentation, and diagnostic work-up of anterior mediastinal mass, especially the one with no clear primary site.","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135387570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madeline Vithya Barnaba Durairaj, Samuel Addo, Rahul Sampath, Kyle David Burnette, Suneel Mohammed
Primary Epstein-Barr virus (EBV) infections are commonly subclinical and seen in adolescents. Although infectious mononucleosis is the most common manifestation, EBV has diverse manifestations within the gastrointestinal system. We describe a rare case of a 27-year-old woman with acute EBV acalculous cholecystitis and hepatitis secondary to cystic duct node lymphadenitis causing compression. EBV-encoded RNA in situ hybridization stained positive within sinusoids of liver and cystic duct lymphoid tissue but negative in gallbladder tissue. Work-up for a cause of hepatitis was negative except for serology confirming primary EBV infection. She underwent laparoscopic cholecystectomy, with a resolution of symptoms.
{"title":"EBV Acalculous Cholecystitis Secondary to Cystic Duct Node Lymphadenitis With Positive EBER in Situ Hybridization","authors":"Madeline Vithya Barnaba Durairaj, Samuel Addo, Rahul Sampath, Kyle David Burnette, Suneel Mohammed","doi":"10.7326/aimcc.2023.0589","DOIUrl":"https://doi.org/10.7326/aimcc.2023.0589","url":null,"abstract":"Primary Epstein-Barr virus (EBV) infections are commonly subclinical and seen in adolescents. Although infectious mononucleosis is the most common manifestation, EBV has diverse manifestations within the gastrointestinal system. We describe a rare case of a 27-year-old woman with acute EBV acalculous cholecystitis and hepatitis secondary to cystic duct node lymphadenitis causing compression. EBV-encoded RNA in situ hybridization stained positive within sinusoids of liver and cystic duct lymphoid tissue but negative in gallbladder tissue. Work-up for a cause of hepatitis was negative except for serology confirming primary EBV infection. She underwent laparoscopic cholecystectomy, with a resolution of symptoms.","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135387578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hyperlipasemia Due to Duodenal Obstruction Secondary to Gastrostomy Tube Migration","authors":"S. Amin, Parth M. Desai, J. Altomare","doi":"10.7326/aimcc.2023.0482","DOIUrl":"https://doi.org/10.7326/aimcc.2023.0482","url":null,"abstract":"","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42828901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune hepatitis and organizing pneumonia are uncommon, yet important, manifestations of drug toxicity. We describe the case of a 67-year-old woman who presented with shortness of breath shortly after completing a course of doxycycline and was incidentally found to have a prominent hepatitis. Subsequent evaluation yielded a diagnosis of doxycycline-induced autoimmune hepatitis and organizing pneumonia. This case gives credence to including drug-induced autoimmune hepatitis and organizing pneumonia in the differential for both liver injury and respiratory failure encountered in the setting of doxycycline exposure.
{"title":"A Rare Case of Doxycycline-Induced Autoimmune Hepatitis With Organizing Pneumonia","authors":"Alex R. Jones, Margaret Kypreos, Mark R. Pedersen","doi":"10.7326/aimcc.2023.0375","DOIUrl":"https://doi.org/10.7326/aimcc.2023.0375","url":null,"abstract":"Autoimmune hepatitis and organizing pneumonia are uncommon, yet important, manifestations of drug toxicity. We describe the case of a 67-year-old woman who presented with shortness of breath shortly after completing a course of doxycycline and was incidentally found to have a prominent hepatitis. Subsequent evaluation yielded a diagnosis of doxycycline-induced autoimmune hepatitis and organizing pneumonia. This case gives credence to including drug-induced autoimmune hepatitis and organizing pneumonia in the differential for both liver injury and respiratory failure encountered in the setting of doxycycline exposure.","PeriodicalId":72222,"journal":{"name":"Annals of internal medicine. Clinical cases","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135387571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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