In the News

Physician-Friendly States for Mental Health: A Review of Medical Boards By Pamela Wibble, MD, and Arianna Palermini, OMS2; Pamela Wibble, MD Blog

December 20, 2019

Announcements Helping in our own way through advocacy

August 16, 2019

Announcements ACP Supports National Physician Suicide Awareness Day, September 17 (National Suicide Prevention Lifeline: 1-800-273-8255 and crisis text line at 741-741)

April 19, 2019

Announcements Thank You So Much to Our Well-being Champion Volunteers at the Champion Training and Internal Medicine Meeting 2019! Thank you so much to all our volunteers who championed well-being as speakers and teachers during the 2019 Internal Medicine Meeting in Philadelphia.

Professional Fulfillment Zone

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!

Noteworthy Resources for Well-being

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!

In The News

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

Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services

Breast Cancer Screening in Average-Risk Women

Long-Term Weight Loss With Metformin or Lifestyle Intervention

Poor Sense of Smell and Risk for Death in Older Adults

Rituximab for Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Scam Awareness Measure Related to Development of Alzheimer Dementia

The MMR Vaccine Is Not Associated With Risk for Autism

Comparing the Effectiveness of Depression Treatments for Patients Undergoing Maintenance Hemodialysis

Compounded Topical Pain Creams to Treat Localized Chronic Pain

Kidney Transplants in Patients With Lupus Nephritis

Events Calendar

MKSAP Quiz: Follow-up evaluation for thrombocytopenia

Surgical, medical options offered similar outcomes for women with urinary incontinence

Confirmatory testing for primary aldosteronism can misinform care

Put words in our mouth

Correction to “Drug Reactions a Risk with NOAC Treatment for Afib”

New ACP paper advises on how to be effective advocates through collective action

Opioid dose escalation, rapid tapering associated with all-cause mortality in older patients

MKSAP Quiz: 3-week history of fever, dyspnea on exertion

Military sexual trauma linked with later suicide attempts, death by suicide or overdose

Drug may lower flu transmission among households, industry trial finds

Take a quiz about the Oct. 1 issue! | ACP Hospitalist

Study finds AI-generated discharge summaries superior to those written by humans | ACP Hospitalist

Incarcerated inpatients | ACP Hospitalist

In-hospital delirium risk varies by race, socioeconomic status | ACP Hospitalist

Factors predict patients being infected with C. auris rather than just colonized | ACP Hospitalist

Cases from the Medical College of Wisconsin | ACP Hospitalist

Biomarker shows promise for longer-term risk prediction in cardiac ED patients | ACP Hospitalist

Type 2 MI increasing, linked to worse long-term outcomes than type 1 | ACP Hospitalist

Take a quiz about the Sept. 24 issue! | ACP Hospitalist

SHM provides checklist for assessing POCUS image quality | ACP Hospitalist

Cryptococcal Meningoencephalitis in an HIV-Negative Host Infected With COVID-19: A Case Report | Annals of Internal Medicine: Clinical Cases

We report a rare case of cryptococcal infection in an immunocompetent adult who initially presented with altered sensorium and acute COVID-19 infection. The suspected diagnosis was encephalopathy due to pneumonia; however, the patient developed new neurologic deficits, warranting further investigation, which revealed cryptococcal meningoencephalitis. HIV testing was negative, but CD4 lymphocytopenia was seen, which resolved after treatment for both COVID-19 and cryptococcal meningoencephalitis. This case illustrates the importance of considering uncommon scenarios in which an opportunistic infection such as cryptococcal meningoencephalitis may present. It also demonstrates the need to frequently consider alternative diagnoses, particularly in the pandemic era.

Colitis Associated With Sevelamer Carbonate: A Case Report | Annals of Internal Medicine: Clinical Cases

Sevelamer carbonate is an anion-exchange, nonabsorbable resin that is commonly used to treat hyperphosphatemia in patients with advanced chronic kidney disease and end-stage renal disease. It is generally well-tolerated with only mild gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and constipation. There have been few case reports of gastrointestinal mucosal injury resulting from sevelamer crystal deposition. The severity of presentation varies from acute inflammation to polyp formation, necrosis, ulceration, and intestinal perforation. We report a 77-year-old woman with end-stage renal disease who was found to have mucosal injury from sevelamer crystal deposition resulting in colitis and ulceration.

A Case of Gigantic Unruptured Abdominal Aneurysm Successfully Treated With Endovascular Repair (EVAR) | Annals of Internal Medicine: Clinical Cases

Aortic aneurysms are focal dilations of more than 50% the normal aortic diameter; giant abdominal aortic aneurysms (AAAs) have diameters greater than or equal to 10 cm and are rare clinical entities. We present a case of an elderly man with an AAA with a 14.6-cm diameter, treated successfully with endovascular repair (EVAR). AAAs pose anatomical challenges for EVAR because of their narrow necks, extreme angulation, and dislocation of intra-abdominal organs. A literature review shows only 5 EVARs have been attempted for the repair of giant AAAs; 4 were successful. With the technical advancement and careful patient selection, successful EVAR of giant AAAs is possible.

Blastic Plasmacytoid Dendritic Cell Neoplasm Mimicking Erythema Nodosum: A Case Report | Annals of Internal Medicine: Clinical Cases

Blastic plasmacytoid dendritic cell neoplasm (BPDCN), previously known as blastic natural killer cell lymphoma, is a rare, difficult-to-diagnose, and aggressive hematologic malignancy. Skin lesions are the initial presentation of BPDCN in 64% to 77% of cases, characterized by brown to purple nodular or bruised macular lesions in solitary or multiple locations. Here, we report the case of a 57-year-old man who initially presented with refractory erythema nodosum symptoms, including fever, arthritis, and painful erythema, and was finally diagnosed with BPDCN after a second skin biopsy. This case illustrates that skin lesions caused by BPDCN mimic ordinary erythema nodosum.

Weakness and Paraparesis: A Common Presentation of the Rare Retrovirus HTLV | Annals of Internal Medicine: Clinical Cases

Limited knowledge exists about human T-lymphotropic virus and its many subtypes, various clinical presentations, devastating sequelae, and potential treatment options. In this case, a 62-year-old woman of Haitian descent presented with a constellation of generalized neurologic symptoms that progressed during an 8-month period and left her bedridden. Although no substantial treatment or cure currently exists, prompt diagnosis of human T-lymphotropic virus is crucial to initiate administration of steroids to both decrease the likelihood of clinical sequelae and help slow the progression of the disease.

Cold Agglutinin Disease–Associated Transient Ischemic Attack, Non-ST Elevation Myocardial Infarction, and Skin Necrosis: A Case Report | Annals of Internal Medicine: Clinical Cases

Cold agglutinin disease is a rare autoimmune hemolytic anemia that preferentially affects female patients and is more common in those older than 60 years. The pathophysiology involves IgM autoantibodies against erythrocytes in areas of the body at cooler temperatures, causing thrombosis and hemolysis. We present the case of a 66-year-old man who was found to have cold agglutinin disease and initially presented with altered mental status, stroke-like symptoms, and non-ST elevation myocardial infarction. Overnight, he also developed striking soft-tissue necrosis of his bilateral feet due to microvascular occlusion. His altered mentation and cardiac ischemia completely resolved; however, he eventually required bilateral phalangeal amputation.

Survival After Ruptured Spontaneous Hepatic Subcapsular Hematoma Following Heparin Initiation for Submassive Pulmonary Embolism | Annals of Internal Medicine: Clinical Cases

Hepatic subcapsular hematomas (HSHs) are rare outside the context of trauma, endoscopic retrograde cholangiopancreatography, and pregnancy. Ruptured HSHs present with abdominal pain and hypotension, with high mortality. We present the patient case of a 69-year-old man readmitted with deep venous thrombosis and pulmonary embolus after uncomplicated laparoscopic prostatectomy. Soon after receiving heparin, he experienced acute abdominal distention and right upper quadrant pain. A large ruptured subcapsular hematoma with focal active bleeding was identified and eventually controlled surgically. We highlight that HSHs can complicate anticoagulant therapy. Awareness and prompt intervention can be lifesaving.

Page Kidney From Ruptured Mycotic Pseudoaneurysm of Renal Artery: An Unusual Complication of Infective Endocarditis | Annals of Internal Medicine: Clinical Cases

Page kidney is an uncommon but potentially reversible cause of secondary hypertension characterized by external compressive force leading to renal hypoperfusion and elevated renin level. Renal artery mycotic aneurysms from infective endocarditis are exceedingly rare. The most feared complication is rupture, which can result in subcapsular hematoma and Page kidney. Early recognition and treatment are crucial to preserving renal function. Imaging and clinical findings aid diagnosis. Angiotensin-converting enzyme inhibitors are usually the first-line treatment of hypertension. Here, we present a rare patient case of ruptured mycotic pseudoaneurysm of the renal artery that complicated infective endocarditis and resulted in Page kidney.

Case of Ibuprofen-Induced Liver Injury | Annals of Internal Medicine: Clinical Cases

Drug-induced liver injury (DILI) resulting from nonsteroidal anti-inflammatory drugs (NSAIDs) is a rare phenomenon; however, several cases have been reported in the literature and the LiverTox database. For ibuprofen in particular, only 22 cases have been reported, and the mechanism for liver injury is unclear. In this report, we discuss a case of ibuprofen-induced liver injury to highlight the evaluation of NSAID-induced DILI, as well as the likely mechanism of injury.

Periorbital Purpura as a Presenting Sign of Hereditary Transthyretin Amyloidosis | Annals of Internal Medicine: Clinical Cases

Cardiac amyloidosis is part of a systemic process caused by extracellular deposition of misfolded protein in various tissues. Once thought to be pathognomonic for AL amyloidosis, here we describe a case of periorbital purpura as a presenting sign in a patient with hereditary transthyretin cardiac amyloidosis.