New ACP Webinars

Listening to Understand, Not to Fix Kerri Palamara, MD, FACP June 12, 10:00–11:00 a.m. ET

In the News

The Joint Commission Statement on Removing Barriers to Mental Health Care for Clinicians and Health Care Staff On May 12, The Joint Commission issued a statement urging organizations to remove barriers that prevent health care workers from seeking mental health treatment.

From the Trenches

Well-being Champions Support Clinician Well-being Through COVID-19 Crisis We appreciate and applaud all our Well-being Champions for the work they are doing on the front lines of this pandemic and on the front lines of fighting burnout and supporting well-being. Below, we wanted to highlight just a few of the many ways our Champions are making a difference.

May 29, 2020

Supporting You Through These Difficult Times

Patients Before Paperwork

On April 9, 2021, ACP co-hosted the Evaluation and Management (E/M) State of the Note Summit with the Electronic Health Record Association (EHRA) to discuss clinical documentation best practices considering the recent 2021 E/M documentation updates. The Summit was attended by various physician societies and EHR vendors. Among other things, a goal of the collaborative work was to identify answers to such questions as how much detail is necessary without adding additional documentation burden and note bloat.

Noteworthy Resources

ACP Well-being Champion Library of Interventions ACP's new Library of Well-being Interventions for Well-being Champions and ACP chapter leaders can assist Well-being Champions in their mission of battling burnout and increasing professional fulfillment in their chapters. Curated resources are grouped into categories that include advocacy; peer support; diversity, equity, and inclusion; organizational interventions; and more. These interventions are easy to implement and can help you with your ACP chapter work.

New ACP Webinars

Back to Basics – Preventing Burnout, Building Trust, and Coping with the EMR Mark Linzer, MD, MACP, and Sara Poplau June 1, 2021, 11 a.m.–Noon ET

In the News

We Need a National Strategy to Help Health Workers Recover From the Stress of the Pandemic By Victor J. Dzau, MD The Los Angeles Times In this opinion article in The Los Angeles Times, Dr. Victor Dzau, Chair of the National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience, argues for a national strategy to measure and respond to clinician burnout.

From the Trenches

By Kerri Palamara, MD, MACP Some call it burnout. Some call it languishing. Others call it loneliness. Regardless of the term you use, it is increasingly clear that the struggle we face as physicians is not only more prevalent but also different from how it's ever been. Many say, “I can't wait for things to go back to normal.” To that, I say, “It had better not!” Rather than things going back to a place where burnout is the norm for physicians, we have an opportunity to create a new normal focused on physician thriving rather than struggling.

May 21, 2021

ACP is offering targeted interventions designed for well-being leaders.

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

Breast Cancer Risk After Childbirth

Benefits and Harms of Using Statins to Prevent Cardiovascular Disease

The Effect of High-Deductible Insurance Plans on Diabetes Care

Comparing Diabetes Outcomes for Primary Care Provided by Physicians, Nurse Practitioners, and Physician Assistants

Effectiveness and Safety of Bariatric Procedures for Weight Loss

Fecal Immunochemical Test Screening for Colon and Rectal Cancer

Stroke Rates, Atrial Fibrillation, and Drugs to Prevent Blood Clots

And the winner is …

ACP debuts travel, entertainment discount program for members

ACP concerned by recent Supreme Court decisions on health care protections

Adverse outcomes more common with dry-powder vs. metered-dose inhaler, study finds

MKSAP Quiz: Evaluation for new-onset ritualistic behaviors

Vapes superior to NRT for smoking cessation in populations with social disadvantage, trial finds

Guidance updated on histoplasmosis

Vote for your favorite entry

CME package of hospital medicine recordings available

Registration open for in-person POCUS courses in St. Louis

RSV, flu increase risk of secondary S. pneumoniae infection, COVID-19 doesn't, study finds | ACP Hospitalist

New COVID-19 vaccines approved for certain groups | ACP Hospitalist

Liberal RBC transfusion threshold doesn't improve quality of life in MI with anemia | ACP Hospitalist

Boarding in the ED on the rise before, worsened during pandemic, study finds | ACP Hospitalist

Take a quiz about the May 28 issue! | ACP Hospitalist

Tackling transfers | ACP Hospitalist

New guidelines on platelet transfusions support restrictive strategies for many patients | ACP Hospitalist

Hybrid HaH model found to be safe alternative to traditional inpatient care | ACP Hospitalist

High inpatient mortality rate, disparities in incidence with candidemia in recent years | ACP Hospitalist

Cognitive outcomes similar between perioperative blood pressure strategies | ACP Hospitalist

Cutibacterium acnes Osteomyelitis 2 Years After Intra-Articular Steroid Injection | Annals of Internal Medicine: Clinical Cases

We present a rare case of a patient who developed shoulder pain 2 years after intra-articular steroid injections and was diagnosed with Cutibacterium acnes osteomyelitis. Upon review of the literature, this represents one of the few documented instances of C acnes osteomyelitis in the absence of invasive surgical procedures. We intend to bring awareness and raise clinician suspicion of this condition, and we hope it can lead to more rapid diagnosis in the future.

Linezolid-Induced Myelosuppression | Annals of Internal Medicine: Clinical Cases

Linezolid is an antibiotic effective against resistant gram-positive bacteria. While side effects are typically mild, myelosuppression can occur, with pancytopenia being a rare but serious condition. We report on a 94-year-old woman who developed pancytopenia following linezolid treatment of cellulitis and myositis. Despite initial stability, her condition necessitated rehospitalization. Hematologic recovery ensued after linezolid was discontinued. This case highlights the need for awareness of linezolid-induced myelosuppression, especially with risk factors like advanced age and sodium–glucose cotransporter-2 inhibitor use. Clinicians should monitor for hematologic adverse effects of linezolid, especially in patients with associated risk profiles.

Hepatitis B Reactivation Following COVID-19 | Annals of Internal Medicine: Clinical Cases

We describe the case of a 83-year-old man who received an allogenic stem cell transplant for acute myelogenous leukemia in 2010. He developed mild COVID-19 illness in 2023 and improved without corticosteroids. Elevated serum transaminase levels were noted, with subsequent evaluation showing a hepatitis B virus (HBV) DNA level measured by polymerase chain reaction of 297 000 000 IU/mL, and positive hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and hepatitis B core antibody (anti-HBc). At baseline, he had a positive anti-HBc and a negative HBsAg. He was treated with entecavir and showed improvement in HBV DNA polymerase chain reaction and serum transaminase levels. Patients with COVID-19 who have persistently elevated serum transaminase levels should be evaluated for HBV reactivation.

An Unusual Presentation of Cholecystocolonic Fistula and Subacute Colonic Obstruction | Annals of Internal Medicine: Clinical Cases

A cholecystoenteric fistula is a spontaneous tract formed between an inflamed gallbladder and surrounding gastrointestinal tract. Cholecystoenteric fistulas most commonly occur between the gallbladder and duodenum but can also occur in other areas. We present a case of a 75-year-old man who presented with new-onset constipation. He was found to have a cholecystocolonic fistula identified via magnetic resonance cholangiopancreatography and a 4.2 cm × 3.7 cm × 5.8 cm obstructing gallstone in the sigmoid colon, requiring manual disimpaction under anesthesia. Although rare, cholecystocolonic fistulas should be considered in the differential diagnosis of older persons with intestinal obstructive symptoms.

A Case of Drug-Induced Aseptic Meningitis Caused by Rozanolixizumab in a Patient With Myasthenia Gravis | Annals of Internal Medicine: Clinical Cases

Rozanolixizumab, a novel therapeutic medication for myasthenia gravis (MG), is a humanized monoclonal antibody against the neonatal Fc receptor. Sold under the brand name Rystiggo, it is the first treatment that the U.S. Food and Drug Administration has approved for adults with MG positive for either anti-acetylcholine receptor (anti-AchR) or anti–muscle-specific kinase (anti-MuSK) antibodies. A 32-year-old woman with MG positive for anti-MuSK antibody presented to the emergency department with a severe headache, neck stiffness, photophobia, and fever after receiving her first dose of rozanolixizumab. Medication-induced aseptic meningitis was diagnosed. This case highlights drug-induced aseptic meningitis as a serious adverse effect of rozanolixizumab.

Arterial Thromboembolism in a Patient With Cancer With Unclear Etiology | Annals of Internal Medicine: Clinical Cases

A 57-year-old man with chronic lymphocytic leukemia presented with acute ischemia of the left lower extremity. The patient was taken for emergent surgical thrombectomy of the common femoral artery and the thrombus was submitted for pathologic evaluation, which showed chronic lymphocytic leukemia lymphocytes commensurate in the thrombus. The patient had no classic risk factors for atherosclerosis. Although he does have active malignancy and is undergoing treatment, his current regimen has a low risk for thrombotic events. Furthermore, the histopathology indicates possible involvement of lymphocytes. This case highlights the need for more understanding of the mechanism of cancer-associated thromboembolic events.

Inverted Supinator Reflex | Annals of Internal Medicine: Clinical Cases

A 77-year-old woman developed progressive numbness in her arms that extended bilaterally from the hands to the forearms. She had a positive inverted supinator sign, indicating inverted supinator reflex, which led to a diagnosis of cervical spondylosis myelopathy.

Surgical Therapy for a Giant Coronary Sinus Thrombus Associated With Persistent Left Superior Vena Cava | Annals of Internal Medicine: Clinical Cases

Coronary sinus thrombosis (CST) is rare, and consensus on optimal treatment remains elusive. This article details the presentation and management of a large CST in a 73-year-old female patient. Notably, the case involves persistent left superior vena cava (PLSVC), a rare congenital anomaly complicating the scenario. The patient was successfully treated with on-pump surgery and postoperative anticoagulant therapy. Our findings advocate for a comprehensive understanding of CST, highlighting potential efficacy in combined surgical and anticoagulant strategies, particularly in cases with PLSVC. This underscores the necessity for further research to refine diagnostic and treatment approaches for complex CST scenarios.

Perivascular Endothelial Carcinomas: An Uncommon Hepatic Tumor Requiring Resection | Annals of Internal Medicine: Clinical Cases

Perivascular endothelial carcinomas (PEComas), rare mesenchymal tumors, often originate in the genitourinary system and seldom occur in the liver. Typically benign and asymptomatic, they mimic hepatocellular carcinoma on imaging studies. We report a compelling case of PEComa in a 78-year-old woman presenting with epigastric pain. Imaging demonstrated a solitary hepatic lesion, with biopsy confirming benign PEComa. Initially monitored, the mass exhibited progressive growth, necessitating liver wedge resection, which was performed without subsequent recurrence or complications. This case underscores the importance of considering PEComa in the differential diagnosis of liver masses, ensuring accurate diagnosis and appropriate management.

Epstein-Barr Virus–Associated B-Cell Lymphoproliferative Disorder Involving the Adrenal Gland in Granulomatosis With Polyangiitis | Annals of Internal Medicine: Clinical Cases

Epstein-Barr virus (EBV)–associated lymphoproliferative disorders (LPDs) are rare conditions. Immunomodulatory therapies impair T-cell–mediated immune responses to latent EBV-infected memory B cells, promoting their reactivation and leading to the excessive division of infected cells, which can result in the development of EBV-associated lymphocyte proliferations. Lymphoproliferative disorders related to immunomodulatory agents are recognized as potential life-threatening complications of prolonged immunomodulator administration. Methotrexate-associated LPDs in rheumatoid arthritis and azathioprine-associated LPDs in inflammatory bowel disease have been reported previously. To our knowledge, we report a unique and possibly the first documented case of a B-cell LPD, specifically an EBV-associated polymorphic LPD, involving the adrenal gland in a patient with granulomatosis with polyangiitis treated with azathioprine.

Ultrasound-Guided Lumbar Puncture

Demonstration of proper lumbar puncture technique and practice on high-fidelity simulation models. Receive feedback from expert faculty and discuss pre- and post- procedure protocol.

Internal Medicine Meeting 2026: Guest Program

ACP welcomes guests! Registered guests have access to the Exhibit Hall for 3 days and admission to the Opening Ceremony. Registered guests may include family members (16 years of age or older) or friends who are not in the medical industry. A coworker or an associate in the medical industry may not register as a guest.

Internal Medicine Meeting 2026 Virtual

Join us virtually live online. Experience an extraordinary curation of top peer educators, clinically pertinent education to improve your knowledge and practice, and the best learning in internal medicine. Access over 100 livestreamed sessions led by expert faculty during the 3-day event. Continue to learn and earn CME/MOC with on-demand access to all recorded sessions for 30 days after the event. For your best value, choose the Premium Access add-on to receive post-meeting recordings for one year after the Meeting.

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