In the News

May Is Mental Health Awareness Month! Please explore the links below for information and toolkits on mental health:

From the Trenches

Learn the Importance of Self-Awareness and System Change “Truly Attending: Cultivating Attention, Presence and Self-Awareness Through Narrative Medicine Workshops” Rhode Island Medical Journal: Mariah Stump, MD, MPH, FACP, Marion Mull McCrary, MD, FACP, and Fariha Shafi, MD, FACP

May 16, 2025

Promoting Mental Health Awareness & ACP Internal Medicine Meeting 2025 Recap

Patients Before Paperwork

Advocacy in Action Congressional News and Perspectives ACP Champions Reauthorization of the Dr. Lorna Breen Health Care Provider Protection Act Passage of the reauthorization bill would expand the national education and awareness campaign and continue to provide solutions to reduce health care worker burnout.

Noteworthy Resources

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

April 18-20 is the ACP Internal Medicine Meeting in Boston. Join us on Friday, April 19, from 3:30-4:30 p.m. for a Networking Social. by the American College of Physicians Explore the ACP Internal Medicine Meeting 2024 well-being page to design an experience best suited to your well-being and professional fulfillment interests and needs. Save the date and join your fellow WBCs and meet other meeting attendees and ACP Leaders at the Networking Social in the Career and Professional Development Center (Exhibit Hall AB).

From the Trenches

I.M. Ready | March 2024 Learn how to 'Live Your Best Life' by Jennifer Kearney-Strouse

ACP Multimedia Education

Mini But Mighty Skills for Well-being: Peer Coaching to Support Individuals and Organizations (15 minutes) Identify core coaching skills and ways to leverage them to support a colleague(s) in need. View here!

March 29, 2024

Patients Before Paperwork

ACP Advocate Newsletter Feature: State of the Union Address Included Promising Proposals for Improving the U.S. Health Care System ACP encouraged by president's pledge to improve mental health care, continue premium subsidies for marketplace health insurance, and provide additional funding to combat COVID-19.

Death and Cardiac Arrest in U.S. Triathletes

Immunoglobulin Treatment for Complex Regional Pain Syndrome

Duration of Sedentary Episodes Is Associated With Risk for Death

Continuous Glucose Monitoring in Patients With Type 2 Diabetes

Different Effects of Screening on Prostate Cancer Death in Two Trials

Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults

Is Coffee Consumption Associated With Lower Risk for Death?

Whole-Genome Sequencing in Primary Care

Yoga, Physical Therapy, or Education for Chronic Low Back Pain

Treatment of Low Bone Density or Osteoporosis to Prevent Fracture

Diamonds are forever, or are they?

Build your career into your job description

Put words in our mouth

Finerenone reduces worsening heart failure despite frailty status, industry trial finds

Falls leading to more deaths in adults ages 65 years and older, CDC says

MKSAP Quiz: 4-month history of thigh pain

New guidance recommends tapering benzodiazepine use for most older adults

ACC recommends medication as first-line treatment for obesity

And the winner is …

Fecal transplant noninferior to vancomycin for first C. diff infection, trial finds

Apixaban superior to rivaroxaban, warfarin for preventing VTE recurrence | ACP Hospitalist

A system for rounding | ACP Hospitalist

Take a quiz about the April 30 issue! | ACP Hospitalist

Severe burnout affects 1 in 10 internal medicine physicians, survey finds | ACP Hospitalist

Save lives by treating substance use | ACP Hospitalist

Inequities in opioid prescribing for pain common among hospitalized patients | ACP Hospitalist

Genomic surveillance system identified outbreaks, saved lives in a hospital trial | ACP Hospitalist

Be guarded about guardianship | ACP Hospitalist

AI-generated discharge summaries similar in quality to physician-written versions | ACP Hospitalist

Understanding charity care | ACP Hospitalist

Swimming Pools Causing Electromagnetic Interference on Cardiac Devices: A Case Series | Annals of Internal Medicine: Clinical Cases

Electromagnetic interference (EMI), also called radiofrequency interference, is unwanted electromagnetic signals from extracardiac sources that are detected by cardiac pacemakers or defibrillators, potentially affecting device therapies. After device implantation, patients are educated about the risks for EMI from sources like cell phones or laptops, but swimming pools often are not included in this discussion. We report 2 cases of EMI from swimming pools that resulted in inappropriate device therapies. Although no catastrophic events occurred in these cases, EMI has the potential to cause changes in device therapy that may lead to devastating clinical outcomes.

Transient Man-in-a-Barrel Syndrome Secondary to Vertebral Artery Stenosis Case Report | Annals of Internal Medicine: Clinical Cases

Man-in-a-barrel syndrome (MIBS) is a neurologic condition characterized by bilateral upper extremity weakness, leaving the arms confined to the sides of the body, and typically results from cortical pathologies. We present an unusual case of MIBS where symptoms manifested because of anterior spinal artery hypoperfusion secondary to vertebral artery stenosis. This case challenges conventional MIBS causes and highlights the importance of considering cervical spinal cord hypoperfusion in the differential diagnosis. This case may help expand the understanding of MIBS, emphasizing a need for broader consideration, extending beyond cortical origins to include cervical spinal cord hypoperfusion.

Recurrent Cardiac Sarcoid in a Post-Heart Transplant Patient: A Case Report | Annals of Internal Medicine: Clinical Cases

Sarcoidosis is defined by the development of granulomas, which affect virtually any organ. While the pathogenesis is poorly understood, treatment consists of immunosuppression, and in the case of cardiac sarcoid, may require a heart transplant. This report describes a patient with cardiac sarcoid who developed a disease recurrence 11 years after heart transplantation. This manifestation in itself is rare; however, this is also the longest reported span of time before recurrence. Her disease is refractory to prednisone and mycophenolic acid. Further studies need to be conducted regarding the treatment of sarcoid recurrence, as immunosuppression is very difficult in these patients.

Relapsed Antineutrophilic Cytoplasmic Antibody–Associated Vasculitis Presenting as Diplopia | Annals of Internal Medicine: Clinical Cases

A 39-year-old man with a history of antineutrophilic cytoplasmic antibody–associated vasculitis in remission presented to the emergency department with 1 month of diplopia. Imaging revealed an infiltrating extraconal enhancing mass along the floor of the left orbit involving the left inferior rectus muscle. Biopsy demonstrated granulomatous inflammation and vasculitis consistent with recurrence of his antineutrophilic cytoplasmic antibody–associated vasculitis. Symptoms resolved with resumption of immunosuppression.

Chronic Mpox Infection | Annals of Internal Medicine: Clinical Cases

A 36-year-old man who has sex with men, recently diagnosed with HIV, presented with progressively worsening multiple large skin ulcers. The initial symptoms, beginning as genital ulcers, appeared 2 weeks after unprotected intercourse with an anonymous male partner and later spread throughout the body. Hematologic analysis revealed a CD4 count of 1.3 × 108 cells/L. Syphilis serologies were reflective of serofast state with known previous treatment. Skin biopsies ruled out fungal, mycobacterial, or malignant conditions. Four weeks after admission, new vesicles appeared on his right arm. Mpox was eventually confirmed by polymerase chain reaction, indicating chronic mpox infection.

Diffuse Subcutaneous Scalp Involvement of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | Annals of Internal Medicine: Clinical Cases

A 63-year-old man presented to the oncology clinic reporting diffuse scalp swelling for the last 3 months. Magnetic resonance imaging of the head showed diffuse scalp swelling, calvarium destruction, and intracranial extension of the tumor. Biopsy specimens from the scalp confirmed diffuse involvement of chronic lymphocytic leukemia/small lymphocytic lymphoma. A positron emission tomography scan confirmed scalp involvement of lymphoma without other pathologic lymphadenopathy. The patient received treatment with Zanubrutinib and responded significantly with complete resolution of scalp swelling in 2 months. Skin involvement of chronic lymphocytic leukemia/small lymphocytic lymphoma is rare, and isolated scalp involvement is seldom reported in the literature.

Acute Liver Failure Secondary to Diffuse Large B-Cell Lymphoma Discovered on Explant Pathology | Annals of Internal Medicine: Clinical Cases

Acute liver failure (ALF) secondary to diffuse large B-cell lymphoma is rare and is associated with a high mortality rate. Active malignancy is considered a contraindication to liver transplantation and immunosuppression. A 55-year-old woman was transferred to our hospital with ALF of unknown cause, underwent transplantation, and was found to have diffuse large B-cell lymphoma on explant pathology. Her posttransplant immunosuppression was minimized while she received chemotherapy. The patient is in remission from cancer, with excellent graft function at 1 year after transplantation. This case serves as an important example of the role of liver transplantation in a rare oncologic cause of ALF.

Clostridium subterminale Empyema in a Patient With Pulmonary Embolism | Annals of Internal Medicine: Clinical Cases

Clostridium subterminale is rarely a source of infection in humans, with only a handful of cases reported over the last several decades. Secondary to the low virulence of this specific species, there is a paucity of literature on pulmonary infections caused by this bacterium. We present a case of a patient with C subterminale empyema with a recent history of submassive pulmonary embolism associated with pulmonary infarction.

Diagnosis of Adult IgA Vasculitis With Gastrointestinal Involvement | Annals of Internal Medicine: Clinical Cases

Immunoglobulin A vasculitis (IgAV) is challenging to diagnose in patients with isolated gastrointestinal (GI) manifestations, as clinical symptoms and endoscopic findings are variable, in addition to mimickers of the disease. Delayed diagnosis can lead to inadequate treatment and complications such as GI bleeding or bowel perforation. We present a case of IgAV in an older man with immunosuppression who presented with abdominal pain, vomiting, and hematochezia. Through serologic testing, radiographic imaging, and repeat endoscopies, the underlying diagnosis evolved from infectious enteritis to mesenteric ischemia, to inflammatory bowel disease, and colchicine toxicity before arriving at the final diagnosis of IgAV.

Systemic Inflammatory Response Syndrome After MitraClip | Annals of Internal Medicine: Clinical Cases

An octogenarian patient with multiple comorbid conditions, including heart failure with preserved ejection fraction and primary mitral valve regurgitation, presented with shortness of breath. After echocardiographic confirmation of severe mitral valve regurgitation, the patient underwent mitral transcatheter edge-to-edge repair with the placement of 2 MitraClips (Abbott). After the procedure, the patient developed an unexplained fever, leukocytosis, tachycardia, and tachypnea concerning for possible procedural complications. The course was further complicated by the onset of delirium after the initiation of antibiotic therapy. The infectious work-up results were negative, and the patient's condition improved, suggesting a systemic inflammatory response syndrome.