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Championing Well-being Together Partnering with Your Chapter and Chapter Staff

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ACP Physician Peer Coaching—available for purchase starting October 1! The wait is finally over! ACP Physician Peer Coaching is here!

Patients Before Paperwork

Advocacy in Action Persevere Along the Trail of Your Advocacy Journey By Shari M. Erickson, MPH, for I.M. Matters ACP members took to the Capitol for Leadership Day to address reducing administrative burden, compensating physicians for the value of care they provide, and supporting programs that strengthen the physician workforce. View here!

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ACP: Design Your Own Well-being Program Explore these tools to create a well-being program tailored to any organization's needs and budget. View here!

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ACP Election Toolkit: Voter Registration and Equitable Access to Elections In December 2023, ACP published a policy brief, which seeks to inform physicians, medical students, and other health care professionals of the links between electoral processes and health; encourage civic participation; and offer policy recommendations to support safe and equitable access to electoral participation to advance health equity for both patients and health care professionals.

From the Trenches

Learn the Power of Personal Stories for Effective Advocacy “Not Superheroes: Holding Space for Physicians to Grieve” By Oyepeju Abioye, MD, MSc, and Omotomilola Fadipe, MD, Annals of Internal Medicine: Annals Fresh Look Blog Drs. Abioye and Fadipe ponder ways to help physicians grieve given the fast-paced nature of the health care environment. Read here!

September 20, 2024

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Displaying 171 - 180 of 500 in Annals of Internal Medicine: Clinical Cases

Triple Flexion Reflex | Annals of Internal Medicine: Clinical Cases

We present here a clinical video demonstrating a triple flexion reflex caused by a plasma cell tumor infiltrating the spinal canal. This involuntary movement is a characteristic and rare manifestation that occurs in association with spinal cord compression and can be observed without motor weakness. Therefore, the clinician should carefully examine the spine even if the patient has little or no muscle depression.

The Unregulated Opioid: Neurologic and Electrolyte Imbalance From Long-Term Kratom Use | Annals of Internal Medicine: Clinical Cases

Mitragyna speciosa, commonly known as kratom, is a Southeast Asian herb gaining popularity as an alternative to opioids for chronic pain and opioid withdrawal treatment. The U.S. Food and Drug Administration classifies it as a “new dietary ingredient” with the potential to damage the kidneys, liver, and heart. Despite this, kratom is widely available in drug stores and online. We present a case of a patient with long-term daily use of kratom who exhibited altered mental status and focal neurologic deficits with hyponatremia 1 week after abruptly discontinuing kratom use. This case underscores the necessity of obtaining a comprehensive history of all regularly consumed medications and supplements, whether prescribed or otherwise.

A Case of Sarcoidosis of the Gallbladder Wall | Annals of Internal Medicine: Clinical Cases

A 37-year-old man with pulmonary and hepatic sarcoidosis was hospitalized for right upper quadrant pain. Imaging showed a heterogeneous mass extending from the gallbladder, and biopsy confirmed sarcoidosis in the gallbladder wall, requiring continuation of his home steroid therapy. This case demonstrates an alternative differential diagnosis to consider when evaluating masses in the hepatobiliary system, especially in patients with sarcoidosis, as well as the utility of various imaging modalities.

Febrile Ordeal: A Case of Human Herpesvirus 8–Induced Hemophagocytic Lymphohistiocytosis in a Cardiac Transplant Patient | Annals of Internal Medicine: Clinical Cases

Hemophagocytic lymphohistiocytosis (HLH) occurs due to the proliferation of the mononuclear phagocytic system, resulting in marked hemophagocytosis. The nonspecific clinical and laboratory findings make the diagnosis of HLH a challenge. Here, we present a postcardiac transplant patient with recurrent fever of unknown origin who was found to have HLH induced by human herpesvirus 8 infection. Our patient's nonspecific symptoms made it challenging to arrive at the diagnosis, which delayed management.

Ectopic Adrenocorticotropic Hormone–Producing Renal Cell Carcinoma Causing Psychosis in a Patient With Birt-Hogg-Dubé Syndrome | Annals of Internal Medicine: Clinical Cases

This is, to our knowledge, the first-ever recorded case of Birt-Hogg-Dubé syndrome associated with an adrenocorticotropic hormone–secreting renal cell carcinoma. A 35-year-old woman who presented with new-onset psychosis, hypertension, and diabetes was found to have severe hypokalemia and elevated cortisol and adrenocorticotropic hormone levels. Imaging revealed a renal mass, pathology confirmed chromophobe renal cell carcinoma, and genetic testing confirmed Birt-Hogg-Dubé syndrome. The patient underwent right partial nephrectomy, with resolution of her symptoms reported.

Management of Severe Hypophosphatemia in Patient Presenting With Panic Attack | Annals of Internal Medicine: Clinical Cases

We report the case of a 33-year-old woman brought by emergency medical services because of sudden-onset chest pressure, dyspnea, and subsequent panic attack with bilateral cramping of all extremities after albuterol trial. Cardiac causes were ruled out, and a comprehensive metabolic panel was significant for electrolyte abnormalities including hypokalemia and severe hypophosphatemia of 0.8 mg/dL. Hypophosphatemia is not commonly associated with panic attacks, although reports have established associations. This case reports the lowest phosphate level documented during an acute panic attack, highlighting the necessity of an increased suspicion for electrolyte derangements and ensuring prompt repletion to prevent further complications.

Colorectal Cancer Arising in a Colon Interposition After Esophageal Reconstruction: The Medical Oncology Perspective | Annals of Internal Medicine: Clinical Cases

Severe esophageal disease can be remedied with colonic interposition, a surgical procedure in which the resected esophagus is replaced by a segment of colon. The development of adenocarcinoma in the colon conduit is a rare but growing long-term complication of this procedure. Here, we present a case of colorectal cancer that developed decades after colonic interposition for childhood esophageal injury due to caustic ingestion. We highlight the challenges inherent in evaluation, treatment, surveillance, and survivorship for this unfortunate complication and describe our institution's successful approach to this complex case.

A Rare Intersection: Mosaic Turner Syndrome and Hereditary Hemorrhagic Telangiectasia | Annals of Internal Medicine: Clinical Cases

This case unveils a rare genetic intersection in which autosomal-dominant hereditary hemorrhagic telangiectasia (HHT) and Turner syndrome coexist in a 53-year-old woman. Clinical signs and symptoms included abdominal pain, arteriovenous malformations, and hormonal irregularities. Diagnostic testing revealed Mosaic Turner syndrome and an ENG gene mutation linked to HHT—challenging conventional understanding and prompting exploration of possible shared pathophysiologic mechanisms. The case underscores the necessity of thorough genetic evaluations for patients with overlapping symptoms, offering insights into genetic interactions and personalized treatment approaches.

Navigating Complexity: Spontaneous Psoas Hematoma in MASLD Cirrhosis and Anticoagulation Therapy | Annals of Internal Medicine: Clinical Cases

Spontaneous psoas hematoma is a rare but highly fatal complication of alcohol-associated cirrhosis. Most cases in the literature involve alcohol-related cirrhosis, particularly in Asian populations. We present a case of a 76-year-old White man with cirrhosis due to metabolic dysfunction-associated steatotic liver disease who developed a spontaneous psoas hematoma while on anticoagulation therapy for an extensive deep venous thrombus. Despite blood products and octreotide, his condition deteriorated. After timely discussions about goals of care, treatment shifted to focus on comfort. This case highlights the challenging balance between hypercoagulability and bleeding risk in cirrhosis and illustrates a rare complication.

An Unusual Cause of Gastrointestinal Bleeding | Annals of Internal Medicine: Clinical Cases

This case report discusses a rare cause of gastrointestinal bleeding in an older man with several comorbidities. The colonoscopy revealed a fragile, vegetative mass in the cecum with an abnormal vessel architecture. The histopathologic examination and the immunohistochemical staining of the resected tumor yielded a diagnosis of high-grade angiosarcoma. During the initial work-up for gastrointestinal bleeding, another primary cancer located at the pancreatic tail was discovered incidentally, the latter being an adenocarcinoma. The patient had right hemicolectomy, distal pancreatectomy, and splenectomy. The association of this rare colonic angiosarcoma with another primary tumor and associated comorbidities are discussed.

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