In the News

Championing Well-being Amid COVID-19 (ACP Well-being Champions Featured) by Mollie Frost, ACP Internist Throughout the pandemic's constant challenges, ACP members have taken care of each other by creating supportive spaces, working together, telling stories, and even climbing mountains. For more on this theme, see the sidebar for the essay “The case for centering the patient-physician relationship” by NY ACP Well-being Champion Maria Maldonado, MD, FACP.

March 25, 2022

Internal Medicine Meeting 2022 Well-being Activities and Creating and Sustaining Change Resources

Professional Fulfillment Zone: Internal Medicine Meeting 2025 Preview

Career and Professional Development Center Visit us in the Exhibit Hall Location G!

Patients Before Paperwork

Advocacy in Action Where We Stand…the Latest in ACP Advocacy Efforts ACP advocates for you on policy changes that will make a difference in your daily work, your professional development, and your patients' health. 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

Fighting Medical Misinformation and Disinformation ACP is committed to stopping and preventing the spread of disinformation and misinformation and vigorously supports the use of science and scientific expertise based on the best available evidence. The College's efforts range from publishing evidence-based scientific content weekly, creating educational materials, issuing public statements, and collaborating with like-minded organizations.

From the Trenches

“Well-being interventions for rural health professionals: A scoping review” Skye McKennon, PharmD, BCPS, ACSM-GEI; Suzanne Fricke, DVM, MLIS; Dawn DeWitt, MDMSc, CMedEd, MACP, FRACP, FRCP-London

March 21, 2025

Promoting Well-being at ACP Internal Medicine Meeting 2025

Patients Before Paperwork

With the April 5, 2021, Information Blocking deadline just weeks away, ACP has focused its attention on reinforcing members' understanding of these regulations and supporting efforts to improve interoperability and health information access for patients and physicians.

Noteworthy Resources

I.M. Emotional Support Hub ACP's new I.M. Emotional Support Hub features trusted and curated emotional support resources from both within and outside ACP. Resources include physician peer support, counseling, guidance for organizational leadership, and individual wellness tips. This webpage is designed to reach our most vulnerable members and provide a variety of just-in-time and long-term support as we enter the second year of the COVID-19 pandemic. View here!

Prevalence of Elevated Cardiovascular Risks in Young Adults

Cardiometabolic Abnormalities Among Normal-Weight Persons From Five Racial/Ethnic Groups in the United States

Relationship Between Weight History and Risk for Death

Steroid Injections for Patients With Low Back Pain

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

Internet-Delivered Exercise and Pain-Coping Skills Training for Chronic Knee Pain

Maintaining Weight Loss

Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets

Breast Cancer: Tumor Size and Overdiagnosis

Oral Pharmacologic Treatment of Type 2 Diabetes

FIT screening for CRC before age 50 years associated with reduced mortality

MKSAP Quiz: Epistaxis after emergency therapeutic apheresis

Desogestrel associated with small increase in risk of intracranial meningioma

Proposed Medicaid cuts would undermine financial well-being, increase preventable mortality

Vote for your favorite entry

Measles is back—and we must be ready

Drug eases vasomotor symptoms from endocrine therapy for breast cancer, study finds

MKSAP Quiz: 2-week history of worsening dyspnea

Two meta-analyses compare aspirin to alternative medications

Gen X, millennials showing higher rates of appendix cancer than previous generations

Take a quiz about the April 23 issue! | ACP Hospitalist

New FDA commissioner sworn in | ACP Hospitalist

Intervention reduced restraint use in older inpatients with cognitive impairment | ACP Hospitalist

Initiation of naltrexone at discharge reduced heavy alcohol use at three months | ACP Hospitalist

Hospital-onset resistant infection rate rose during pandemic, stayed elevated | ACP Hospitalist

Falls common after ICU stays, especially in first three months after discharge | ACP Hospitalist

When AI plays doctor | ACP Hospitalist

Therapeutic anticoagulation improves outcomes in sickle cell ACS vs. prophylactic dose | ACP Hospitalist

The spark of contrast in the kidney | ACP Hospitalist

Take a quiz about the April 16 issue! | ACP Hospitalist

Evaluation of the Role of Endomyocardial Biopsy in Rare Myocardial Disorders: Six Case Reports and Narratives | Annals of Internal Medicine: Clinical Cases

This study conducts an observational analysis of 6 cases of rare myocardial diseases, aiming to clarify the diagnostic value and clinical utility of endomyocardial biopsy (EMB) in the 2007 American Heart Association, American College of Cardiology, and European Society of Cardiology guidelines and the 2020 Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and Japanese Heart Failure Society guidelines. Our findings indicated that certain forms of myocarditis may present with arrhythmias and other clinical scenarios, potentially leading to a lower recommendation grade in the 2007 guidelines. To enhance the yield of EMB, electroanatomical mapping systems can be used in some diseases. Endomyocardial biopsy serves as a valuable diagnostic tool in acute-onset unexplained cardiomyopathy and suspected infiltrative diseases. The complications of EMB must be taken seriously.

A Rare Case Report of Amiodarone-Induced Bone Marrow Granuloma | Annals of Internal Medicine: Clinical Cases

Amiodarone has rarely been reported to induce bone marrow granulomas. In this case, we describe the case of a 67-year-old man who was incidentally found to have pancytopenia while receiving amiodarone therapy for 18 months. A bone marrow biopsy revealed noncaseating granulomas, presumably causing pancytopenia. Subsequently, amiodarone was withdrawn, resulting in a gradual improvement of the pancytopenia. The resolution of amiodarone-induced bone marrow granuloma and associated cytopenia is readily achievable through physicians’ awareness and appropriate discontinuation of the medication therapy. Consequently, we recommend considering amiodarone as a potential contributor to bone marrow granuloma and cytopenia.

Reversal of Severe Cardiorenal Dysfunction After Correction of Late-Onset Aortic Obstruction in an Adult Patient | Annals of Internal Medicine: Clinical Cases

Aortic obstruction syndromes are a rare, often neglected cause of secondary arterial hypertension. We present the atypical case of a 55-year-old woman with late-diagnosed aortic obstruction causing hypertension and severe cardiorenal dysfunction. Surgical correction successfully controlled blood pressure and reversed organic dysfunction. This case underscores the importance of considering aortic obstruction syndromes in the differential diagnosis in adults with severe hypertension and highlights the significance of meticulous physical examination for accurate diagnosis, avoiding unnecessary complex interventions and contributing to long-term patient well-being.

Successful Daratumumab, Lenalidomide, and Dexamethasone Treatment of Refractory Type I Cryoglobulinemia From Monoclonal Gammopathy of Undetermined Significance | Annals of Internal Medicine: Clinical Cases

Cryoglobulinemia is a rare inflammatory condition, with 3 major types, and has infectious, autoimmune, or malignant etiologies. Cryoglobulinemia can lead to systemic vasculitis that will require identification of the underlying cause to tailor treatment. While most patients with type I cryoglobulinemia are treated effectively with immunosuppressive therapies, here we present a case in which type I cryoglobulinemia caused by IgG lambda monoclonal gammopathy of undetermined significance was refractory to first-line therapies. This prompted use of off-label treatment with a standard multiple myeloma therapy regimen targeting plasma cells, with clinical and laboratory complete response.

More Than 20 Centimeters of Intracardiac Cement Removed After Kyphoplasty | Annals of Internal Medicine: Clinical Cases

Intracardiac cement embolization through the venous system is a potentially deadly complication of the vertebroplasty and kyphoplasty. We present a case involving a 55-year-old woman who exhibited dyspnea on exertion, chest pain, and back pain 2 weeks after a kyphoplasty of the T12 vertebrae. The patient had open-heart surgery to remove a winding intracardiac segment of cement more than 20 cm long. Our review of the literature suggests this is one of the largest intracardiac cement emboli removed to date.

Erdheim–Chester Disease With MAP2K (p.K57N) Mutation Diagnosed With Kidney Biopsy | Annals of Internal Medicine: Clinical Cases

This case study presents Erdheim–Chester disease (ECD) diagnosed by kidney biopsy in a middle-aged woman who needed hemodialysis. She was admitted with dyspnea, congestive heart failure, and acute kidney injury. A kidney biopsy revealed histiocytosis renal infiltration and molecular mutation (MAP2K p.K57N) in the mitogen-activated protein kinase (MAPK) pathway, confirming ECD. Corticosteroid treatment resulsted in recovered renal function after 3 months. To our knowledge, this is the first well-documented case of this association. In patients with acute kidney injury and histiocytosis infiltration in the kidney, ECD should be considered, with steroids being a plausible treatment of histiocytosis infiltration in the kidney.

A Case of Cosecretion of Parathyroid Hormone-Related Protein and 1,25-Dihydroxyvitamin D in Small Cell Lung Carcinoma Presenting as Symptomatic Hypercalcemia | Annals of Internal Medicine: Clinical Cases

A 75-year-old man presented with altered mental status in the setting of hypercalcemia. Computed tomography imaging showed a new right upper lobe lung lesion and extensive metastatic disease of the spine. Biopsy specimens of the lung revealed small cell carcinoma. Laboratory tests revealed hypercalcemia, low parathyroid hormone levels, and elevated parathyroid hormone-related protein, 1,25-dihydroxyvitamin D, and chromogranin A levels. We review a case of cosecretion of parathyroid hormone-related protein and 1,25-dihydroxyvitamin D by small cell carcinoma of the lung presenting as symptomatic hypercalcemia of malignancy, for which diagnosis can be challenging. To our knowledge, this would be the first case reported in the medical literature.

Insulin Autoimmune Syndrome (Hirata Disease) After Treatment With Alpha-Lipoic Acid: A Case Report | Annals of Internal Medicine: Clinical Cases

We present the case of a 79-year-old White woman with recurrent spontaneous hypoglycemia characterized by low plasma glucose, inappropriately elevated plasma C-peptide and insulin levels, and the presence of antibodies against endogenous insulin. Imaging for insulinoma was negative. The diagnosis of insulin autoimmune syndrome, or Hirata disease, was established. Continuous glucose monitoring data were consistent with the pathophysiology of insulin autoimmune syndrome. It was associated with the patient's previous treatment with an oral supplement containing alpha-lipoic acid. Frequent, small, low carbohydrate–content meals resulted in the elimination of hypoglycemic events.

Hypophosphatasia | Annals of Internal Medicine: Clinical Cases

Hypophosphatasia is a significantly heterogeneous disease caused by loss of function mutations in the alkaline phosphatase gene. Hypophosphatasia can manifest with dental and skeletal issues from birth to adulthood. This disease can be missed and underdiagnosed; therefore, it is important for clinicians to maintain a high index of suspicion for unexplained skeletal and dentition abnormalities.

A Case of Combined Baclofen and Carisoprodol Withdrawal: The Hidden Dangers of Muscle Relaxants | Annals of Internal Medicine: Clinical Cases

Muscle relaxant prescriptions are on the rise for the treatment of chronic pain, although physician education about the effects of overdose, medication interactions, and withdrawal is limited. Simultaneous use of the muscle relaxants baclofen and carisoprodol can result in withdrawal at relatively low doses, possibly because of their synergistic effect. Prior case reports have described withdrawal from either of these muscle relaxants. However, this case report describes the course of a patient who was experiencing withdrawal from both baclofen and carisoprodol. To address such scenarios appropriately, it is important for prescribers to be aware of the withdrawal syndromes associated with these medications.