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.

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 CenterVisit 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!

Paternal and Maternal Metformin Use and the Risk for Major Congenital Malformations

Feeling the Heat: Cardiovascular Consequences of Heat Exposure Under Controlled Experimental Conditions

Medicare Advantage: High Costs and Poor Protection

Strategic Allocation of a Finite Resource: Clinician Brain Power

Long COVID: The Enduring Pandemic

The Cost-Effectiveness of Prostate Cancer Screening That Incorporates Magnetic Resonance Imaging

The Heap, the Hype, the Reality: Generative Pretrained Transformer for Systematic Reviews

The More Things Change, the More They Stay the Same: Understanding the Safety of Outpatient Care

The Relationship of Sex Steroid Hormones and Clinical Outcomes Is Complex

Annals Video Summary - Long COVID Definitions and Models of Care: A Scoping Review

Pathway offers practical approaches to monitoring for poststroke arrhythmia

Put words in our mouth

Expert clinical decision pathway details diagnosis, management of myocarditis

Hyperglycemia risk increased in COPD patients taking glucocorticoids

MKSAP Quiz: Evaluation for mild dementia

Studies consider cardiovascular risk prediction in women, all U.S. adults

Care models reduce opioid dosage in patients with chronic pain

And the winner is …

Governor-elect election results announced

AI-powered tool addresses conversations on obesity management

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

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

A Case of Spontaneous Isolated Superior Mesenteric Artery Dissection in a Patient With Celiacomesenteric Trunk Anomaly | Annals of Internal Medicine: Clinical Cases

Celiacomesentric trunk (CMT) is a rare vascular anomaly with a common origin for the celiac artery and superior mesenteric artery. To our knowledge, this is the first case of superior mesenteric artery (SMA) dissection in patients with CMT. Here, we discuss a case of a 65-year-old male with acute-onset epigastric pain who was found to have SMA dissection with CMT. He was treated conservatively with symptomatic improvement. Diagnostic imaging studies include computed tomography (CT) scanning of the abdomen with or without contrast and CT angiography. Management options include a conservative approach, endovascular repair, and surgical management based on the classification/location of the dissection.

Euglycemic Diabetic Ketoacidosis Related to SGLT2 Inhibitor Use in a Patient With Cobalamin C Deficiency and Diabetes | Annals of Internal Medicine: Clinical Cases

A 24-year-old woman with cobalamin C deficiency (CblCD), autoimmune thyroiditis, and recently diagnosed diabetes mellitus presented with weight loss, emesis, and abdominal pain. She had been placed on sodium-glucose cotransporter inhibitor (SGLT2i) therapy because of metformin intolerance, with the addition of a dipeptidyl peptidase-4 inhibitor. Biochemical analyses demonstrated severe acidosis, initially attributed to CblC-associated metabolic decompensation. Subsequent evaluation led to the diagnosis of SGLT2i-induced euglycemic diabetic ketoacidosis in a patient with type 1 diabetes mellitus. This case highlights the importance of assessing for insulin deficiency when evaluating acidosis and the management challenges of common diseases in adults with inherited metabolic disorders.

Colon Perforation in the Setting of Sevelamer Crystals | Annals of Internal Medicine: Clinical Cases

Sevelamer is frequently used as a phosphate binder in patients with end-stage renal disease. It can also cause gastrointestinal side effects including colitis, obstruction, and, rarely, perforation.

First Manifestation of Adult-Onset Still Disease After COVID-19 Vaccination: Two Cases | Annals of Internal Medicine: Clinical Cases

Adult Still disease (ASD) is a rare autoinflammatory condition of unknown cause. Viral or bacterial infections can trigger the onset of ASD. We describe the clinical features, treatment, and follow-up of 2 patients with new-onset ASD following COVID-19 vector vaccination. Our cases emphasize the importance of early diagnosis and lend weight to an association between COVID-19 vector vaccination and new-onset ASD.

Cutaneous Vasculopathy and Recalcitrant Lower-Extremity Ulcerations | Annals of Internal Medicine: Clinical Cases

Lower-extremity ulcerations are a frequent cause of hospitalization, and those that persist despite appropriate treatment warrant careful scrutiny. We present a case of chronic, progressive leg ulcerations in a young woman accompanied by oral and genital ulcers and retiform purpura. Repeat skin biopsy revealed an intravascular lymphoid infiltrate ultimately consistent with T-cell prolymphocytic leukemia, and she was treated successfully with alemtuzumab and allogeneic hematopoietic stem cell transplantation. Our case illustrates the importance of maintaining a broad differential for patients with ulcers recalcitrant to treatment or with acute on chronic worsening. Our report also highlights the successful response of this aggressive disease to hematopoietic stem cell transplantation.

Idiopathic, Self-limiting Bilateral Bell Palsy | Annals of Internal Medicine: Clinical Cases

Bilateral facial palsy is exceedingly rare, representing only 0.3% to 2.0% of facial palsy cases (1). In contrast to the oft-recognized unilateral facial palsy, bilateral facial palsy is usually related to an underlying systemic disorder with a broad range of differentials including infections, autoimmune disorders, and sarcoidosis.

Rumpel-Leede Phenomenon | Annals of Internal Medicine: Clinical Cases

We report a case of Rumpel-Leede phenomenon in an 80-year-old man presenting in the context of lightheadedness, dizziness, and elevated at-home blood pressure readings. In this case, the finding was found quite incidentally, by a routine blood pressure measurement, and was characterized by a purpuric rash on both upper extremities, which was nonpalpable and nonblanching with pressure. The pathophysiology of this rare clinical entity involves acute rupture of dermal capillaries from capillary fragility, resulting in a self-limiting nonpurpuric rash that resolves spontaneously without intervention.

Coccidioides Meningitis: An Unusual Presentation of a Devastating Disease | Annals of Internal Medicine: Clinical Cases

Coccidioidomycosis, a fungal infection caused by the dimorphic Coccidioides genus, spans from asymptomatic exposure to fatal disseminated disease, most notably meningitis. A patient in a nonendemic area presented with neurologic symptoms and imaging concerning for subarachnoid hemorrhage. Cerebral angiogram and cerebrospinal fluid analysis were inconsistent with hemorrhage, and subsequent imaging revealed leptomeningitis. Further history revealed previous travel in endemic regions and laboratory studies confirmed disseminated coccidioidomycosis. This patient case illustrates the importance of obtaining a thorough epidemiologic history and maintaining a high clinical suspicion despite an unusual presentation.

Gradenigo Syndrome: Retro-orbital Pain, Abducens Palsy, and Petrous Apicitis | Annals of Internal Medicine: Clinical Cases

Gradenigo's syndrome is a rarely encountered triad of otitis media, retro-orbital pain, and abducens nerve palsy. Originally described in the early 1900s by Giuseppe Gradenigo, it is the physical manifestation of a lesion involving the petrous apex of the temporal bone, oftentimes in the setting of a pneumatized petrous apex/temporal bone; a noted normal anatomical variant that may predispose to infection. Local irritation of the ipsilateral trigeminal and abducens nerves leads to retro-orbital pain and abducens palsy, respectively.

Bouveret Syndrome: Rare but Quite Impactful | Annals of Internal Medicine: Clinical Cases

Bouveret syndrome is a rare cause of gastric outlet obstruction that arises from a gallstone passing through a choledochoduodenal fistula. It remains poorly understood and is frequently misdiagnosed. We describe a case in which a patient was successfully treated for Bouveret syndrome. The patient presented with recurrent abdominal pain, anorexia, and intractable nausea and vomiting. Esophagogastroduodenoscopy revealed a large, affected stone in the proximal duodenum. The stone was removed via exploratory laparotomy, and the patient was discharged with a prescription for ursodiol. This case aims to serve as a guide to physicians in the early identification of Bouveret syndrome.