Internal Medicine Commons^™

A Case Of Neurogenic Orthostatic Hypotension Secondary To Pure Autonomic Failure, Lauren Cooper, William Studt, Rayan Islam, Richard Weinberger

The Journal of Integrated Primary Care

Neurogenic orthostatic hypotension (nOH) is a debilitating manifestation of autonomic dysfunction and is most commonly associated with neurodegenerative disorders, though it can occur in isolation. Pure autonomic failure (PAF) is a rare and often underrecognized cause of nOH, particularly in older adults. We report the case of an 80-year-old man with hereditary hemochromatosis who presented with recurrent falls due to severe orthostatic hypotension. Orthostatic vitals demonstrated a marked blood pressure drop with minimal heart rate response consistent with a neurogenic etiology. He lacked motor, cognitive, or sensory features of neurodegenerative disease, and extensive evaluation excluded secondary causes, supporting a diagnosis …

Faktor-Faktor Yang Berhubungan Dengan Infeksi Laten Tuberkulosis Pada Pasien Lupus Eritematosus Sistemik Dan Artritis Reumatoid Di Rsupn Dr. Cipto Mangunkusumo, Fahmi Adnan Musthofa, Herikurniawan Herikurniawan, Ceva Wicaksono Pitoyo, Alvina Widhani, Ari Fahrial Syam, Rudi Putranto, Sally Aman Nasution, Noto Dwimartutie, Suryo Anggoro Kusumo Wibowo

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are at increased risk of latent tuberculosis infection (LTBI) because of immune dysregulation and prolonged immunosuppressive therapy. However, data on the prevalence and factors associated with LTBI among patients with autoimmune diseases in Indonesia remain limited. This study aimed to identify factors associated with LTBI among adult outpatients with SLE and RA at Dr. Cipto Mangunkusumo National General Hospital (RSCM).

Methods. This analytic cross-sectional study was conducted at the Allergy-Immunology and Rheumatology Outpatient Clinic of RSCM from November 2025 to July 2026. Data were obtained through structured …

Hubungan Skor Rale Gambaran Foto Toraks Dengan Kadar D-Dimer Pada Pasien Covid-19, Marsa Zaidan, Arifin Arifin, Sulistyani Kusumaningrum, Ratih Tri Kusuma Dewi

Jurnal Penyakit Dalam Indonesia

Introduction. COVID-19 pneumonia caused by SARS-CoV-2 leads to extensive pulmonary infiltrates. The Radiographic Assessment of Lung Edema (RALE) score is a quantitative radiological tool to evaluate the severity of lung lesions. Meanwhile, elevated D-dimer levels reflect coagulation and fibrinolysis activation. This study aimed to analyze the correlation between the initial RALE score on chest radiography and D-dimer levels upon hospital admission.

Methods. An analytical observational study with a cross-sectional design was conducted on hospitalized COVID-19 patients at Dr. Moewardi Hospital, Surakarta, from March to July 2021. A total of 98 patients were selected via simple random sampling based …

Faktor Risiko Yang Berhubungan Dengan Kejadian Gangguan Ginjal Akut Pada Pasien Covid-19 Di Rsupn Dr. Cipto Mangunkusumo, Radita Ikapratiwi, Pringgodigdo Nugroho, Herikurniawan Herikurniawan, Alvina Widhani, Ikhwan Rinaldi, Muhammad Yamin, Anna Ariane, Syahidatul Wafa

Jurnal Penyakit Dalam Indonesia

Introduction. Coronavirus disease 2019 (COVID-19) affects not only the respiratory system but also cause systemic complications, including acute kidney injury (AKI). The occurrence of AKI in COVID-19 patients is associated with increased mortality and morbidity. Global data indicate that AKI occurs in approximately 4,3–50,6% of hospitalized COVID-19 patients, particularly among the elderly and those with comorbidities. This acute impairment of kidney function may worsen the course of the disease and increase the burden on hospital services. This study aimed to determine the proportion of AKI and analyze the risk factors associated with the occurrence of AKI in COVID-19 patients …

Korelasi Indeks Massa Tubuh Dengan Kekuatan Otot Dan Performa Fisik Pada Lansia Sarkopenia Di Posyandu Lansia Palembang, A. Deza Farista, Nur Riviati, Ridzqie Dibyantari, Erial Bahar, Taufik Indrajaya, Melani Melani, Michael Jonathan Tan, Crisnah Indah, Indah Aprilia

Jurnal Penyakit Dalam Indonesia

Introduction. The number of older adults in Indonesia continues to increase, and so does the number of older adults with sarcopenia. The decline in muscle mass, muscle strength, and physical performance can reduce quality of life. Body Mass Index (BMI) is easy to measure at community health posts, but it is unclear whether BMI reflects muscle strength and physical performance in older adults who already have sarcopenia. This study aimed to analyze the correlation between BMI and muscle strength and physical performance in older adults with sarcopenia.

Methods. This analytical observational cross-sectional study was conducted from September to …

Percutaneous Closure Defek Septum Atrium Sekundum Sangat Besar Menggunakan Amplatzer Septal Occluder Dengan Panduan Fluoroskopi Dan Transesophageal Echocardiography: Laporan Kasus, Todung Silalahi, Mulyadi M. Djer

Jurnal Penyakit Dalam Indonesia

Atrial septal defects (ASD) are one of the most common acyanotic congenital heart lesions. Clinical presentations, complications, and appropriate device sizing are challenging for percutaneous approach. We report a successful percutaneous closure of extreme large secundum ASD with mild pulmonary hypertension, using amplatzer septal occluder (ASO) with fluoroscopic and transesophageal echocardiography guidance (TEE) in a 26-year-old female. Implantation was successful, and no complications were observed during the one month of follow-up.

Peran Sel Punca Pada Perawatan Psikosomatik Dan Paliatif, Vinandia Irvianita Poespitasari, Muhammad Nabil, Dian Pritasari Jeger, Edward Faisal, Rudi Putranto, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

In recent decades, stem cell therapy has gathered attention as an innovative strategy to address various complex conditions. In psychosomatic cases, stem cells have the potential to restore the function of tissues affected by chronic stress responses, reduce systemic inflammation, and enhance neuroimmune balance. Meanwhile, in palliative care, this therapy offers hope for tissue regeneration and improved quality of life for patients with terminal illnesses through immunomodulatory effects and the alleviation of chronic pain. Although early results are promising, stem cell therapy in the context of psychosomatic and palliative care remains in the early stages of research, facing significant challenges …

Spektrum Keterlibatan Ginjal Pada Infeksi Virus, Anandhara Indriani Khumaedi

Jurnal Penyakit Dalam Indonesia

No abstract provided.

A Mixed Methods Study Of Inpatients’ Experiences, Priorities, And Health-Related Quality Of Life During High- Flow Nasal Cannula Therapy, Cintamani H. Ellsworth, Rebecca S. Bartlett

Journal of Patient-Centered Research and Reviews

Purpose: High-flow nasal cannula (HFNC) is an oxygen delivery method with numerous benefits for severely ill patients. There is a paucity of research focused on the perspectives of patients receiving HFNC oxygen therapy. This study aimed to engage with patients to gain a clearer understanding of their experiences, priorities, and health-related quality of life.

Methods: A cross-sectional, mixed methods study was completed with 10 adult inpatients who had received HFNC oxygen therapy during their hospital admission. Semi-structured interviews and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale were used to identify participant perceptions of their physical and …

Bell’S Palsy In Pregnancy Following Covid-19 Infection: A Case Report, Maria Camila Gonzalez Tovar, Abelardo Rodriguez, Oluwatobi Olonisakin, Mounika Kotte, Aramide Tijani

Research Symposium

Background: Bell’s palsy is a peripheral facial nerve paralysis. The development of this is suspected to be a result of viral-induced inflammation, ischemia, immune-mediated mechanisms or idiopathic. Even though it can occur in the general population, pregnancy is a recognized risk factor. The incidence of Bell’s palsy during pregnancy and the postpartum period ranges from 60.5 to 171.6 cases per 100,000 person-years, with about 69% of pregnancy-associated cases occurring in the third trimester or within the first two months postpartum. Emerging evidence has shown an association between COVID-19 infection and an increased risk of Bell’s palsy, with studies demonstrating a …

Pharmacist-Led Initiative To Increase Naloxone Prescribing For Patients On High-Dose Opioids In A General Internal Medicine Clinic, Christine E. Leduc, Hyun J. Lee, Polly D. Fraga

The Lahey Journal

Abstract

Introduction:

Opioid overdose is a pressing public health concern in the United States. In 2022, prescription opioids were involved in 15% of all opioid deaths.1 Despite CDC recommendations for prescribing naloxone to high-risk patients, primary care physicians prescribe only 1.5 naloxone prescriptions per 100 prescriptions of high-dose opioids.2,3 Strategies are needed for healthcare institutions to expand naloxone access and mitigate opioid-related harm. This pilot study assesses the impact of a pharmacist-led quality improvement patient outreach initiative on increasing naloxone prescribing for adult patients taking ≥ 50 MME per day of prescription opioids as recommended by current CDC guidelines.

Methods: …

Medetomidine As A Fentanyl Adulterant: Pharmacology, Detection, Clinical Presentation, And Management, Kory S. London, Phil Durney, Brendan Hart, Ashish Thakrar, Dennis Goodstein, Alex J. Krotulski, Daniel Teixeira Da Silva, Joseph D’Orazio, Lara Weinstein, Jeanmarie Perrone, Michael J. Lynch

Division of Internal Medicine Faculty Papers & Presentations

Purpose of Review Medetomidine is a veterinary α2-adrenergic agonist that has been an adulterant of illicitly manufactured opioids since 2022. We review its pharmacology, detection, intoxication, withdrawal, and management, and assess why severe withdrawal has emerged in some regions but not others. Recent Findings Medetomidine has spread through North American drug markets yet evades most toxicology testing. Roughly two hundred times more potent than xylazine, with greater α2 selectivity and imidazoline-1 activity, it causes intoxication resembling other α2 agonists: sedation and bradycardia. The dominant clinical problem is withdrawal: autonomic dysregulation, intractable vomiting, and encephalopathy frequently requiring intensive care. Treatment requires …

The High Cost Of Incomplete Physical Exams: Missed Diagnosis Of Cushing Syndrome In A Patient With Recurrent Hospital Admissions, Tarah M Burton, Miranda K Hunter, Mihail Zilbermint

Journal of Community Hospital Internal Medicine Perspectives

Cushing syndrome is a rare but life-threatening endocrine disorder associated with a classic constellation of physical exam findings (e.g. “moon facies”, abdominal striae, etc.). However, thorough biochemical testing is needed to confirm this diagnosis. We present the case of a 35-year-old male with multiple hospitalizations across a variety of healthcare institutions for heart failure, cellulitis, uncontrolled hypertension, and diabetes.  While an adrenal mass was eventually identified on imaging, classic signs of Cushing syndrome – including violaceous striae, truncal obesity, and facial plethora – were missed during prior admissions.  This case illustrates the diagnostic delay that can result from incomplete physical …

Clinical And Laboratory Predictors Of 30-Day Mortality In Hiv-Positive Adults With Pneumonia: A Prospective Observational Study From North India, Mandip Singh Bhatia, Ankita Kumari Bhargav, Saurabh Chandrabhan Sharda, Shankar Naidu, M. R Shivaprakash, Sunil Sethi, Vikas Gautam, Arnab Ghosh

Journal of Community Hospital Internal Medicine Perspectives

Background: Pneumonia remains a major cause of morbidity and mortality among people living with HIV (PLHIV), particularly in low- and middle-income countries. Despite the availability of antiretroviral therapy (ART), early mortality after hospitalization for pneumonia remains high. Indian data on short-term mortality predictors in HIV-associated pneumonia are limited.

Methods: We conducted a prospective observational study of HIV-positive adults admitted with pneumonia to a tertiary-care hospital in North India between April and December 2025. Clinical, laboratory, microbiological, and radiological parameters were recorded at admission. Patients were followed for 30 days. The primary outcome was all-cause 30-day mortality. Predictors of …

Pulmonary Adenocarcinoma Arising From Somatic-Type Malignant Transformation Of A Nonseminomatous Germ Cell Tumor: A Case Report, Abdel Martinez Borrego, Brandon Cantazaro, Fatimah Bello, Christine Vega, Natacha Vargas, Payal Bhakta, Renzo Arauco

School of Medicine Publications

Somatic-type malignant transformation (STM) is a rare but aggressive complication of nonseminomatous germ cell tumors (NSGCTs), most commonly arising from the teratomatous component and frequently occurring in metastatic sites. We report the case of a man in his 20s with a history of mixed NSGCT (50% yolk sac tumor, 40% teratoma, and 10% embryonal carcinoma) treated with left orchiectomy and chemotherapy in 2023, who initially responded to treatment but was subsequently lost to follow-up. He presented with one week of progressive dyspnea and pleuritic left-sided chest pain. Serum alpha-fetoprotein was markedly elevated at 2,966.7 ng/mL. Computed tomography demonstrated a progressive …

Endocarditis Caused By Candida (Candidozyma) Auris, Farah Ebrahim, Mzee Ngunga, Abdulaziz Abeid, Hilda Nasibwa, Newnex Mongare, Rodney Adam

Internal Medicine, East Africa

Candida (Candidozyma) auris has emerged as a hospital-acquired pathogen and was first reported in East Asia in 2009. Infective endocarditis due to C. auris has been rarely reported, while other Candida species account for < 2% of infective endocarditis (IE) cases. Herein we report three cases of endocarditis caused by C. auris , including a native aortic valve, a native tricuspid valve, and a prosthetic valve. Each of these cases had been in healthcare settings months to years earlier that were the likely sources of their infec- tions. These cases suggest the possibility for indolent but life-threatening infections from C. auris . ©2026 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Responding To Medetomidine In Philadelphia: Narrative Summary Of The Public Health Response To A New Psychoactive Substance, Tareva Warrick-Stone, Serge-Emile Simpson, Phil Durney, Dennis Goodstein, Catherine Abrams, Raymond Bobb, Kory London, Daniel Teixeira Da Silva

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Despite the emergence of medetomidine as the dominant adulterant in Philadelphia's illicit opioid supply, coordinated public health responses are limited or non-existent in the literature. Thus, we summarize a recent Summit in Philadelphia of outpatient and inpatient service providers who specialize in the care of persons who use drugs to discuss medetomidine response readiness and building ongoing community readiness for potential destabilizing drug supply changes.

PURPOSE: Describe a public health intervention that distributed information about practices across health care settings and mobilized key informants to identify and address barriers to treatment.

METHODS: Descriptive summary of the in-person Summit organized …

Maternal Sjögren's Disease And Its Long Shadow: Adult-Onset Seronegative Lupus Nephritis Following Congenital Heart Block, Tatiana Dacak, Abelardo Rodriguez, Luisa Fernanda Gomez, Corey Haines, Nida Asif

School of Medicine Publications

Congenital complete atrioventricular block (CCAVB) is a well-recognized manifestation of neonatal lupus erythematosus (NLE), caused by transplacental transfer of maternal anti-Ro/Sjögren's Syndrome Type A (SSA) and anti-La/Sjögren's Syndrome Type B (SSB) antibodies. Although non-cardiac manifestations of NLE typically resolve within the first year of life, the long-term autoimmune risk in affected offspring remains unclear. We report a 24-year-old woman with CCAVB secondary to maternal Sjögren's disease who presented with acute heart failure, nephrotic-range proteinuria, bicytopenia, pericardial effusion, and findings concerning for Libman-Sacks endocarditis. Despite negative conventional lupus serologies, renal biopsy demonstrated Class IV/V lupus-like immune-complex glomerulonephritis with full-house immune complex …

Beyond The Clot: A Rare Case Of Extensive Dvt And Pulmonary Embolism Revealing May-Thurner Syndrome, Jorge A. Aboytes, Jose J. Loayza, Ivan Mogollon, Daniel Pena, Michelle Lopez

Research Colloquium

Introduction: Deep vein thrombosis (DVT) in young adults is uncommon and typically associated with identifiable risk factors. In cases where DVT occurs without apparent provocation, congenital anatomical anomalies should be considered. May-Thurner Syndrome (MTS), a vascular compression disorder involving the left iliac vein, is a frequently overlooked cause of iliofemoral DVT in young individuals, particularly women.

Case Presentation: A 28-year-old woman with no significant medical history presented with acute left leg swelling, pain, and discoloration, along with new-onset dyspnea and chest discomfort. She had recently transitioned to a contraceptive patch and reported reduced mobility due to fatigue. Imaging confirmed left …

A Misplaced Pocket Of Air: Intramural Gastric Air Most Consistent With Gastric Emphysema, Priyanka Panwar, Lavender Otom, Subo Marsa, Gerald Odong, Steven Idet, Irene Muchiri, Hussein Abdulsamad, John Odhiambo, Christopher Opio, Amos Mwasamwaja, Saleem Abdulkarim

Internal Medicine, East Africa

Background Gastric emphysema (GE), or gastric pneumatosis, is a rare, noninfectious cause of intramural gastric air that must be distinguished from emphysematous gastritis (EG), a highly lethal infectious entity. Despite similar radiographic appearances, these conditions differ substantially in etiology, clinical course, management, and prognosis.

Cases We report three hemodynamically stable patients with CT-confirmed intramural gastric air most consistent with GE. Two had associated portal venous gas. The cases occurred in distinct clinical contexts: infectious gastroenteritis with retching, transient midgut volvulus with obstructive gastric overdistension, and alcohol-related upper gastrointestinal bleeding with forceful vomiting and a Mallory–Weiss tear. Although early EG could …