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Displaying 271 - 280 of 7513 in ACP Online

May 19, 2023

Nurturing Connections Through ACP Resources

Professional Fulfillment Zone

Recap of the Internal Medicine Meeting held in Boston, MA, April 18-20, 2024 The Career and Professional Development Center in the Exhibit Hall was a one-stop shop for networking, Physician Peer Coaching, Mini But Mighty Skills sessions, and recharging in the Well-being Fun Zone.

Patients Before Paperwork

Advocacy in Action New ACP Leadership Shares Dedication to Strengthening the Voice of Physicians Dr. Isaac O. Opole, new ACP President, and Dr. William E. Fox, new Chair of the ACP Board of Regents, both credit involvement in ACP for their professional success.

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

The Biden-Harris Administration, through the U.S. Department of Health and Human Services (HHS), just released the 2024 National Strategy for Suicide Prevention and accompanying Federal Action Plan. Watch the HHS Secretary explain in 90 seconds this groundbreaking new initiative and how YOU can help. "Suicide is a complex public health problem, tragically impacting our friends, family members, neighbors and community members nationwide," said HHS Secretary Xavier Becerra.

From the Trenches

Learn the importance of: "Being There" From Travis Hoover, MD, resident physician in radiation oncology at the University of Maryland Read here! "How Do Our Minds Help (or Hinder) Finding Connection & Purpose?" From the latest episode of Surgeon General Dr. Vivek Murthy's House Calls podcast

May 17, 2024

Professional Fulfillment Zone

Internal Medicine Meeting 2025 Recap

Patients Before Paperwork

Advocacy in Action New ACP Policy Paper Offers Guidance to Reduce Disparities and Improve Access to Health Care in Rural Communities ACP Advocate, April 2025 As rural communities continue to face disparities in health and access to health care, the American College of Physicians is urging policymakers to take action and offers guidance in a new policy paper published in Annals of Internal Medicine.

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!

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Displaying 271 - 280 of 500 in Annals of Internal Medicine: Clinical Cases

Nicoladoni-Branham Sign in the Coronaries: Fistula Closure Leads to Immediate Relief | Annals of Internal Medicine: Clinical Cases

We describe the first reported case, to our knowledge, of Nicoladoni-Branham sign in a patient with a large right coronary artery to superior vena cava fistula presenting with high-output heart failure. Percutaneous closure of the fistula resulted in immediate symptomatic relief and resolution of sinus tachycardia. It is important to recognize this physiologic mechanism not only to resolve high-output heart failure but also to relieve patients from years of unrelenting dyspnea, palpitations, and discomfort.

A Case of Undifferentiated Shock Due to Probable Voriconazole-Related Primary Adrenal Insufficiency | Annals of Internal Medicine: Clinical Cases

Adrenal insufficiency (AI) can be a rare effect with azole antifungals, classically, ketoconazole. Whether AI can be observed with newer triazole drugs used for treating invasive fungal infections is far less understood. A 65-year-old man taking voriconazole for Aspergillus pneumonia was admitted to the intensive care unit with confusion and shock. He had hyperkalemia, hyponatremia, and refractory hypotension that resolved with high-dose prednisone for gout and withdrawal of voriconazole. He was discharged with a regimen of isavuconazole and 1 week later was found again with a morning cortisol level of 63.48 nmol/L (reference range, 165.60–507.84 nmol/L] and electrolyte derangements, along with symptoms of AI. His symptoms fully resolved with steroid and mineralocorticoid replacement.

Emphysematous Gastritis and Portal Venous Gas | Annals of Internal Medicine: Clinical Cases

We present a rare case of emphysematous gastritis and portal venous gas triggered by severe sepsis, likely causing gastrointestinal hypoperfusion, transmural ischemia, and ileus. This condition facilitated the local translocation or hematogenous spread of gas-forming organisms into the gastric wall. Prompt identification of computed tomography findings and early initiation of therapy led to favorable outcomes. This case highlights a critical medical scenario that requires swift diagnosis and intervention.

Saving a Life by Recognizing the Rash: Niacin (Vitamin B3) Deficiency in Hartnup Disease With a Clinical Debut in Adulthood | Annals of Internal Medicine: Clinical Cases

Tryptophan deficiency can lead to a critical shortness of niacin (vitamin B3), causing photosensitive dermatitis and a range of neurologic symptoms. The most common cause is severe protein malnutrition. However, in the case we present here, it is caused by a rare genetic disorder (Hartnup disease). A previously healthy 26-year-old woman presented with a photosensitive skin rash, myoclonic twitching of hands and mouth, and, ultimately, coma and status epilepticus. Starting treatment with high-dose niacin, even before the suspected diagnosis was confirmed, turned out to be a lifesaving intervention.

A Case of Transverse Myelitis From Varicella-Zoster Virus in a Patient Who Was Immunocompetent | Annals of Internal Medicine: Clinical Cases

Transverse myelitis is a neurologic disorder that stems from focal inflammation of the spinal cord. Varicella-zoster virus can induce this disease, occurring in 0.3% of infected patients. This is a case of a 67-year-old man who presented with headache and weakness. Magnetic resonance imaging scan and cerebrospinal fluid from lumbar puncture confirmed transverse myelitis from varicella-zoster virus. Because of the rarity of the disease, its detection can be missed, and without early recognition and treatment, this condition can cause paralysis and death. This case also underscores the importance of prophylaxis and educating patients on vaccination for prevention of the virus itself.

Indolent Systemic Mastocytosis: An Incidental Diagnosis | Annals of Internal Medicine: Clinical Cases

Indolent systemic mastocytosis (ISM) is the most prevalent subtype of systemic mastocytosis, characterized by a clinical course progressing over several years to decades. We present a case of a 57-year-old woman with symptoms of flushing and occasional dizziness who was diagnosed with ISM after a colon polyp biopsy revealed CD3-, CD20-, and CD25-positive atypical mast cell infiltrates. The patient was started on antihistamines with advice to avoid triggering factors. This case raises awareness about mast cell disorders. Clinicians should always keep these disorders in mind while evaluating a patient with nonspecific signs and symptoms involving multiple organ systems.

Capnocytophagia Meningitis Secondary to Dog Bite to the Face | Annals of Internal Medicine: Clinical Cases

Capnocytophagia canimorsus is known to cause cellulitis, septicemia, endocarditis, and meningitis, most commonly in an immunocompromised host following an animal bite injury. Here, we describe an unusual case of Capnocytophagia meningitis in an immunocompetent host without classic risk factors. The severity of presentation was believed to be related to the high-risk location of the dog bite near the danger triangle of the face.

Bloodstream Infection Caused by Williamsia spp., a Frequently Misidentified Emerging Pathogen | Annals of Internal Medicine: Clinical Cases

Williamsia species have been isolated from many disparate environmental sources but only 4 cases of human infection have been reported previously. We now report the first case of W spongiae bacteremia, illustrating the difficulty in recognizing this genus of an emerging health care–associated pathogen.

Postviral Platelet-Activating Anti-PF4 Disorder Responsive to High-Dose Intravenous Immunoglobulin | Annals of Internal Medicine: Clinical Cases

A 54-year-old man presented with diffuse bleeding and thrombosis and was initially considered to have immune thrombocytopenia and, later, disseminated intravascular coagulation. Ultimately, the condition was determined to be due to a platelet-activating antiplatelet factor 4 (anti-PF4) disorder, preceded by an upper respiratory infection in the absence of prior heparin use. The heparin antibody assay showed a highly positive titer at 2.301 OD, with a strongly positive serotonin release assay at 78% with 0.1 U/mL unfractionated heparin, confirming the diagnosis. We successfully managed the postviral anti-PF4 disorder with intravenous immunoglobulin, in addition to anticoagulation with argatroban.

Peliosis Hepatis: A Vascular Tumor-Like Liver Lesion | Annals of Internal Medicine: Clinical Cases

Peliosis hepatis (PH) is a rare tumor-like lesion of the liver. Causes are numerous, including medications, toxins, malignancies, and infections. We present a case of PH in a 28-year-old woman who was referred to our clinic after an ultrasound revealed multiple liver lesions. The diagnosis of PH was made after a liver biopsy and was attributed to her use of oral contraceptive pills. The aim of this case report is to familiarize physicians with PH and to aid in diagnosis and management.

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