COVID-19 (SARS-CoV-2) infection presenting as acute urticaria.

In addition to typical respiratory clinical manifestations,1 patients with SARS-CoV-2 infection may also exhibit extrapulmonary clinical manifestations. As we continue to discover more about SARS-CoV-2, it is becoming evident that its presentation, course of disease, and clinical manifestations differ from person to person. Not only that, it is presenting with a wide range of findings, skin manifestations might be one of the rare signs of the disease.2 We encountered a unique case in our outpatient setting via telemedicine. Our patient presented with usual signs and clinical manifestations of the disease and developed a total body urticarial eruption with red margins and raised skin-colored center 4 days after our initial encounter. Later, she tested positive for COVID-19. She did not require hospitalization and was managed with supportive care and antihistamines.

Recurrent urinary tract infections in an adult with a duplicated renal collecting system.

Because of advancements in fetal imaging, anatomic variants of the genitourinary tract are most often discovered in the antenatal period. As such, general internists are less likely to encounter adult patients with previously undiagnosed anatomic abnormalities of the renal collecting system, such as duplicated kidneys. These abnormalities put patients at risk for urinary obstruction and recurrent infections of the urinary tract. We report the case of a 40-year-old diabetic patient with a previously undiagnosed duplex kidney who had recurrent episodes of diabetic ketoacidosis triggered by urinary tract infections. She was ultimately found to have abscess formation in the duplicated renal moiety. We reviewed the epidemiology, diagnosis, and management of duplex kidneys. We also reviewed the indications for renal imaging in adult patients with similar clinical presentations.

Are Men at High Risk for Osteoporosis Underscreened? A Quality Improvement Project.

CONTEXT: Osteoporosis is a major cause of morbidity and mortality in both men and women. The mortality rate in men within 1 year of hip fracture is 37.5%, which is 51% higher than in women. Although clear guidelines exist for osteoporosis screening in women, these are less clear for men. The available guidelines recommend screening high-risk men; however, screening does not appear to be a standard practice. OBJECTIVE: To increase screening rates of osteoporosis in high-risk men in our primary care clinic by 50%. DESIGN: The screening rate of osteoporosis was determined in high-risk male veterans more than 50 years of age enrolled in the resident physician- and nurse practitioner-staffed primary care clinics at a Veterans Affairs Medical Center in Cleveland, OH. High-risk factors included prolonged use of steroids; hypogonadism; and autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus, which are known to be associated with osteoporosis. We surveyed health care professional trainees and nurses to explore their barriers to screening for osteoporosis in high-risk men. MAIN OUTCOME MEASURES: After creating awareness about the importance of this condition among the health care professionals, we analyzed whether this education had any impact on the screening rate. RESULTS: The baseline screening rate in high-risk men was 11%. After phased surveys and awareness building, the screening rate increased to 20%. CONCLUSION: Osteoporosis in high-risk men is under-screened. Creating more awareness about the impact of this condition among health professional trainees and nurses can lead to improved screening rates.