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Displaying 181 - 190 of 7608 in ACP Online

Group Coaching for ACP Well-being Champions

There is still time to sign up for group coaching sessions facilitated by ACP Physician Services Coaching Lead, Dr. Kerri Palamara. Well-being Champions will be grouped into cohorts to participate in monthly group coaching sessions over Zoom. Champions will be able to discuss well-being goals and interventions and plan collaborative efforts.

From the Trenches

September 18, 2020

Answering the Call for Our Members and Our Communities

Patients Before Paperwork

Fact Sheet: Calendar Year (CY) 2022 Medicare Physician Fee Schedule Proposed Rule | CMS

Noteworthy Resources

Physician Suicide Prevention and the Ethics and Role of a Healing Community: An American College of Physicians Policy Paper Matthew DeCamp, MD, PhD, and Mark Levine, MD, for the ACP Ethics, Professionalism and Human Rights Committee

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Protective equipment for physicians' mental health By Mollie Frost ACP Internist

From the Trenches

After a Physician Dies by Suicide By Ryan DuBosar ACP Internist This article shares the multiple factors that contribute to physician death by suicide, advocating for systems changes, destigmatizing mental health help-seeking in the culture of medicine, and creating supportive communities for those associated with or affected by the tragic event. View here!

ACP Webinars

Know Your Colleagues, Know Yourself: Checking In on Mental Health Liz Lawrence, MD, FACP

September 17, 2021

Individual and Organizational Resources That Give Agency and Provide Nurturing Safe Spaces and Supportive Communities If you or someone you know is in crisis, help is available 24/7. Text 741741 or call the National Suicide Prevention Lifeline (988 or 1-800-273-8255) or Disaster Distress Hotline (1-800-985-5990).

October 18, 2019

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Displaying 181 - 190 of 500 in Annals of Internal Medicine: Clinical Cases

Pituitary Apoplexy as a Mimicker of Infectious Meningitis in an Adolescent Female Patient | Annals of Internal Medicine: Clinical Cases

Pituitary apoplexy can cause a chemical meningitis, and its mimicry in presentation with infectious meningitis poses a diagnostic challenge. Here we report an 18-year-old woman who presented with acute headache, altered mental status, and cerebral spinal fluid (CSF) pleocytosis and clinically improved with antibiotics and steroids. Despite an unremarkable computed tomography (CT) scan of the head, brain magnetic resonance imaging showed a pituitary macroadenoma with apoplexy. To our knowledge, this is one of the first reports of an adolescent with pituitary apoplexy masquerading as infectious meningitis and underscores the importance of keeping this rare condition, often missed on CT scans, as part of the differential for CSF pleocytosis.

Delayed Diagnosis of Olfactory Neuroblastoma During the SARS-CoV-2 Pandemic | Annals of Internal Medicine: Clinical Cases

The COVID-19 pandemic has resulted in a delay in cancer diagnosis and treatment during this time. A potential cause of delayed diagnosis that may be underrecognized is a patient misinterpretation of symptoms. To illustrate this point, we present the case of a patient with a delayed diagnosis of olfactory neuroblastoma 2 years after the onset of anosmia.

Near-Simultaneous Development of Coronary and Pulmonary Thrombosis in a Patient With COVID-19 | Annals of Internal Medicine: Clinical Cases

Venous thromboembolism and in situ thrombosis are recognized complications of SARS-CoV-2 infection and are associated with adverse outcomes. The development of multiple thrombotic events in patients with COVID-19 has been reported, although the combination of venous and arterial thrombotic events is rarely recognized. Here, we describe a 42-year-old man without significant risk factors for cardiovascular disease who developed a segmental pulmonary thrombus and coronary thrombus within hours while hospitalized for the treatment of nonsevere COVID-19 pneumonia.

Severe Presentation of Acute Eosinophilic Pneumonia Possibly Secondary to Recent E-Cigarette Use | Annals of Internal Medicine: Clinical Cases

A 52-year-old man with type 2 diabetes mellitus presented with fever and hypoxemic respiratory failure requiring intubation. He had no history of pulmonary disease but recently started smoking nicotine-containing electronic cigarettes (e-cigarettes) after 10 years of tobacco abstinence. He had diffuse bilateral ground-glass opacities on chest imaging, 11% peripheral eosinophilia (absolute eosinophil count 1300/µL), and 50% eosinophilia in the bronchoalveolar lavage fluid without evidence of bacterial, viral, fungal, or parasitic infection. Hypoxia and pulmonary infiltrates rapidly resolved after initiation of high-dose corticosteroids after bronchoscopy. A diagnosis of acute eosinophilic pneumonia was made, possibly secondary to recent e-cigarette use.

Hypertension and Headache in the Setting of Vertebral and Carotid Fibromuscular Dysplasia | Annals of Internal Medicine: Clinical Cases

A 98-year-old woman presented in the context of headache and was found to have evidence of a beaded appearance of the bilateral carotid and vertebral arteries. Fibromuscular dysplasia of the carotid and vertebral arteries is rare but may present with symptoms of headache, dizziness, transient ischemic attack, or stroke. Management of symptomatic patients focuses on the use of antihypertensive drugs and secondary prevention with antiplatelet agents. Surgical intervention is referred for those cases that are nonresponsive to the aforementioned treatments.

Therapeutic Low-Density Lipoprotein Cholesterol-Lowering in a Patient With Familial Hyperlipidemia Refractory to PCSK9 Monoclonal Antibody (Evolocumab) | Annals of Internal Medicine: Clinical Cases

Patients with heterozygous familial hypercholesterolemia if untreated are at increased risk for atherosclerotic cardiovascular disease events by age 40 years. Inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) is a demonstrated potent approach to low-density lipoprotein cholesterol (LDL-C)-lowering in this population. We describe a 67-year-old patient with heterozygous familial hypercholesterolemia who developed a paradoxical increase in LDL-C while on a PCSK9 monoclonal antibody but had a subsequent reduction in LDL-C when started on inclisiran, a PCSK9-directed oligonucleotide. The overall mechanism of monoclonal antibody refractoriness remains to be determined, but it indicates that PCSK9 as a target is still a viable option using a different mechanism.

A Case of Hyperviscosity Syndrome in Rheumatoid Arthritis | Annals of Internal Medicine: Clinical Cases

Hyperviscosity syndrome (HVS) is a rare complication of both monoclonal and polyclonal disorders associated with elevation of immunoglobulins. Here, we describe a female patient who presented with shortness of breath and a history of seropositive rheumatoid arthritis with deformities, significant barriers to care, and poor therapeutic adherence. Her rheumatoid factor titer was greater than 1000 kIU/L, and she had an elevated serum viscosity level with her presentation consistent with HVS which improved significantly after therapeutic plasmapheresis. Our case highlights the presentation of rare but potentially life-threatening HVS that can occur in patients with systemic autoimmune rheumatic disorder.

A Rare Observation of Silicone-Associated Scleroderma-Like Syndrome: How to Recognize and Diagnose Similar Cases | Annals of Internal Medicine: Clinical Cases

Although silicone breast implants are generally considered safe medical devices, implant ruptures and silicone leakage are not uncommon. In this brief report, we describe an unusual case of a woman with ruptured breast implants and long-standing unexplained systemic symptoms. She developed an atypical and localized scleroderma-like syndrome, with a rare observation of histopathologically confirmed silicone depositions in distant sclerotic cutaneous biopsies. This observation with silicone-specific modified oil-red-o staining strongly suggests a direct inflammatory reaction to the distant (sub)cutaneous silicone depositions from her ruptured breast implants. We propose clinical recommendations on how to recognize and diagnose possible similar cases.

Hypertriglyceridemia-Induced Acute Pancreatitis Secondary to Glycogen Storage Disease Type Ia: Successful Treatment With Plasmapheresis | Annals of Internal Medicine: Clinical Cases

Glycogen storage disease type Ia (GSD-Ia) is a rare autosomal recessive disorder caused by a loss-of-function mutation in glucose-6-phosphatase, resulting in recurrent fasting hypoglycemia. This leads to several systemic metabolic complications, including hypercholesterolemia and hypertriglyceridemia, which can induce acute pancreatitis episodes. We report on using early plasmapheresis in addition to oral fibrate therapy as a successful treatment of a 27-year-old GSD-Ia patient with hypertriglyceridemia-induced acute pancreatitis. Plasmapheresis was initiated the day after admission and continued daily for three treatments, ultimately resulting in a seven-day admission.

Pulmonary Reperfusion Injury After Catheter-Directed Thrombectomy for Acute Pulmonary Embolism | Annals of Internal Medicine: Clinical Cases

An 82-year-old man had catheter-directed thrombectomy for intermediate-high–risk pulmonary embolism. Shortly after the procedure, the patient developed new alveolar and interstitial infiltrates found on chest computed tomography (CT) as well as life-threatening hemoptysis, likely related to pulmonary reperfusion injury after thrombus removal. Pulmonary reperfusion injury after minimally invasive thrombectomy in acute pulmonary embolism is a rare and life-threatening complication and should be considered in the differential diagnosis of acute pulmonary hemorrhage syndromes.

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