Search Results for ""

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!

Professional Fulfillment Zone

Announcing ACP Internal Medicine Meeting 2025 Well-being Poster WinnersCongratulations to this year's poster winners in the Physician Well-being and Professional Fulfillment category!

Patients Before Paperwork

Advocacy in ActionVaccines effective, and controversial, since their inventionBy Jason M. Goldman, MD, MACP, for I.M. Matters from ACPThe amount of vaccine misinformation and disinformation in recent years has truly been astounding, ACP's President says.Read here

A Case of Bilateral Subclavian Artery Stenosis Presenting as Refractory Hypotension | Annals of Internal Medicine: Clinical Cases

A 72-year-old woman presented with epigastric pain, hypotension, and tachycardia. Laboratory studies revealed anemia and lactic acidosis. Endoscopy showed gastric cancer without active bleeding. Although the tachycardia and lactic acidosis resolved shortly after a blood transfusion, her blood pressure (BP) remained low. BP measured in both her upper and lower extremities confirmed a discrepancy. Computed tomography revealed findings suggestive of bilateral subclavian artery stenosis. Bilateral subclavian artery stenosis should be suspected in a patient who presents with prolonged unexplained asymptomatic low BP measured in both upper extremities, noting the importance of also measuring the BP in all extremities.

Achromobacter Hepatic Abscess Several Months After Laparoscopic Cholecystectomy: A Case Report and Review of Literature | Annals of Internal Medicine: Clinical Cases

Achromobacter xylosoxidans is a rare pathogen that causes opportunistic and nosocomial infections in immune-compromised patients. After a cholecystectomy, dropped stones can serve as nidus for abscess formation. We describe a rare case of hepatic abscess caused by Achromobacter xylosoxidans in a 40-year-old immune-competent woman who had a laparoscopic cholecystectomy 9 months previously.

A Case of Pseudo-Pseudo Meigs Syndrome as the Initial Presentation of Systemic Lupus Erythematosus | Annals of Internal Medicine: Clinical Cases

Systemic lupus erythematosus (SLE) is a multigenic disease leading to chronic inflammatory states within organ systems. When associated with ascites, pleural effusions, and elevated CA-125 levels, it is known as pseudo-pseudo Meigs syndrome. It is a clinical diagnosis without findings of benign or malignant ovarian tumors in patients with SLE. We present a patient case of a 42-year-old woman who presented with episodic and progressively worsening ascites, bilateral pleural effusions, and elevated CA-125 levels without any evidence of benign or malignant tumors as the initial manifestation of SLE.

When Community-Acquired Pneumonia Guidelines Provide Misguided Guidance | Annals of Internal Medicine: Clinical Cases

Limited diagnostic testing and empirical antimicrobial therapy are recommended in practice guidelines for adults with community-acquired pneumonia (CAP). Although following CAP guidelines is cost-effective with high cure rates, consideration should be given to the possibility that CAP is caused by pathogens not effectively treated by the recommended antibiotic regimens. Expanding the differential diagnosis based on potential pathogen exposures and comorbid conditions can prevent delays in diagnosis and appropriate treatment. As an example, mucormycosis should be considered in a patient presenting with pneumonia in the setting of diabetic ketoacidosis.

A Case of Isolated Cardiac Sarcoidosis: An Underdiagnosed Disease With Little Diagnostic Consensus | Annals of Internal Medicine: Clinical Cases

Sarcoidosis is a rare cause of cardiomyopathy and can be missed when there is no pulmonary involvement. We present the case of a 55-year-old woman with isolated cardiac sarcoidosis who presented with symptoms of worsening intermittent dyspnea, weight gain, and lower extremity swelling. Cardiac evaluation showed a nonischemic cardiomyopathy secondary to an inflammatory cause. Cardiac magnetic resonance and positron emission tomography scans were performed that led to the diagnosis of isolated cardiac sarcoidosis. Recent updates in diagnostic criteria have allowed the use of imaging modalities alone to confirm the diagnosis in place of biopsy.

New-Onset Tongue Weakness Due to Skull Base Metastases to Bilateral Hypoglossal Canals | Annals of Internal Medicine: Clinical Cases

Hypoglossal nerve palsy is a rare disorder resulting in dysarthria and tongue weakness, usually caused by direct nerve compression or injury. Malignant invasion of the skull base can rarely lead to bilateral hypoglossal nerve compression at the exit of the hypoglossal canals. We report the case of a 40-year-old man with stage IV colorectal cancer who presented with tongue weakness and dysphagia and was discovered to have new metastases to his skull base with invasion of his bilateral hypoglossal canals.

A Rare Case of Surfer's Myelopathy in an Athletic Intermediate Surfer | Annals of Internal Medicine: Clinical Cases

Surfer's myelopathy is a nontraumatic spinal cord injury sustained in the setting of prolonged periods of hyperextension with intermittent Valsalva when transitioning from a prone to standing position on a surfboard. This condition almost exclusively occurs in first-time, unathletic surfers. This case report is unique in that an 18-year-old experienced female volleyball player developed surfer's myelopathy after, not her first, but eighth time surfing. In this way, we are contributing to medical education through a case report on the presentation, diagnostics, and treatment of surfer's myelopathy in a non–first-time surfer.

Multisystem Inflammatory Syndrome Leading to Myocardial Infarction After SARS-CoV-2 Vaccination | Annals of Internal Medicine: Clinical Cases

The most common adverse effects of SARS-CoV-2 vaccines are injection site reactions and systemic symptoms, such as fever and malaise, which are typically self-limiting. Multisystem inflammatory syndrome after SARS-CoV-2 vaccination (MIS-V) is rare. In this report, we describe a case of a 22-year-old man who developed MIS-V with myocardial infarction. Optical coherence tomography (OCT) showed blurring of intravascular structure, intimal thickening, and medial vessel destruction. High-dose glucocorticoid and antithrombotic therapy were effective as shown through improvement in OCT findings.

Scurvy's Systemic Clinical Picture: A Multiorgan Presentation of a Conspicuous Disease | Annals of Internal Medicine: Clinical Cases

A man whose diet was limited to consumption of chicken, fish, and bread was admitted for weight loss, dyspnea, and cutaneous lesions. Findings of the physical examination included lower-extremity purpura. Initial work-up demonstrated severe ferropenic anemia, hyperbilirubinemia, vertebral fracture, and dilation of the inferior vena cava and right cardiac chambers. Vitamin C deficiency was documented and, after adequate supplementation, the anemia, hyperbilirubinemia, and bleeding resolved. This case demonstrates the wide, unspecific, and reversible systemic manifestations associated with scurvy, its potential as a great mimicker, and the relevance of nutritional deficiencies even in an apparently nutrient-rich environment.

Sandwich-Associated Lactic Acidosis: A Case Report of a Young Adult With Pyruvate Dehydrogenase Complex Deficiency | Annals of Internal Medicine: Clinical Cases

Pyruvate dehydrogenase complex deficiency is a rare genetic disorder that can lead to severe metabolic consequences. We present the case of a young adult with pyruvate dehydrogenase complex deficiency who presented with progressive shortness of breath and subsequently required intubation in the setting of severe lactic acidemia. After resuscitation and extubation, a targeted history identified that the patient had eaten 3 grilled cheese sandwiches just before admission. In these rarely encountered cases, both detailed clinical history-gathering as well as multidisciplinary provider coordination is essential in ultimately implementing specialized dietary recommendations and thus preventing accelerated morbidity and mortality.