Mycoplasma pneumoniae-Induced Rash and Mucositis in a Previously Healthy Man: A Case Report and Brief Review of the Literature.

We describe a case of a 33-year-old-male with Mycoplasma pneumoniae-induced rash and mucositis and review the literature on this newly described syndrome.

Thymoma associated paraneoplastic encephalitis (TAPE), a potential cause of limbic encephalitis.

A 59-year-old man presents with expressive aphasia and short term memory deficits. Shortly thereafter, he started developing staring spells and intermittent right hand spasms, preliminarily thought to be simple partial seizures. Subsequent MRI brain imaging was highly suggestive of herpes simplex virus (HSV) encephalitis; however, HSV PCR from cerebrospinal fluid was negative. On further testing, the patient was found to have an autoimmune encephalitis thought to be related to an incidentally found thymoma. His clinical presentation, in conjunction with imaging and response to therapy, was strongly suggestive of thymoma associated paraneoplastic encephalitis. Early recognition is the only way to ensure prompt initiation of appropriate treatment. Immunotherapy and cancer directed therapy (including tumour resection, if indicated) have been shown to have favourable outcomes, improved speed of neurological recovery and reduced risk of relapses. Without treatment, progressive neurologic deterioration can occur over months to years, eventually resulting in death.

Sticky Business: a syndrome of mucoid bacterial spread.

A 70-year-old man presented with acute wrist pain concerning for septic arthritis. Shortly thereafter, he developed acute monocular vision loss and was diagnosed with endogenous endophthalmitis. Subsequent imaging revealed numerous visceral abscesses and a mycotic abdominal aortic aneurysm. Cultures, in conjunction with the clinical syndrome, were strongly suggestive of hypervirulent Klebsiella pneumoniae syndrome (hvKP). hvKP syndrome may present with multiple sites of infection or subsequent metastatic spread may develop; the liver, lungs, central nervous system and eye are most commonly involved. Prompt source control and intravenous antibiotic therapy leads to a cure in the majority of patients. This case highlights the risk factors, presentation, management and prognosis of this disease as well as its increasing incidence in North America and Europe.

Painful rash with hoarseness: an atypical presentation of syphilis.

Syphilis is a sexually transmitted disease that can affect multiple organ systems, with central nervous system involvement at any stage. We present a 53-year-old woman with an unusual truncal rash with painful anogenital lesions, accompanied by patchy alopecia, oral lesions, photophobia and hoarseness. She was found to have positive serological tests for syphilis with cerebrospinal fluid findings suggestive of neurosyphilis. She underwent a 14-day course of intravenous penicillin G and exhibited successful resolution of painful anogenital lesions as well as marked improvement in dermatological, oropharyngeal, laryngeal, and neurological symptoms.

General principles of antimicrobial therapy.

Antimicrobial agents are some of the most widely, and often injudiciously, used therapeutic drugs worldwide. Important considerations when prescribing antimicrobial therapy include obtaining an accurate diagnosis of infection; understanding the difference between empiric and definitive therapy; identifying opportunities to switch to narrow-spectrum, cost-effective oral agents for the shortest duration necessary; understanding drug characteristics that are peculiar to antimicrobial agents (such as pharmacodynamics and efficacy at the site of infection); accounting for host characteristics that influence antimicrobial activity; and in turn, recognizing the adverse effects of antimicrobial agents on the host. It is also important to understand the importance of antimicrobial stewardship, to know when to consult infectious disease specialists for guidance, and to be able to identify situations when antimicrobial therapy is not needed. By following these general principles, all practicing physicians should be able to use antimicrobial agents in a responsible manner that benefits both the individual patient and the community.

A survey of resident opinions on peer evaluation in a large internal medicine residency program.

BACKGROUND: Starting in the 1960s, studies have suggested that peer evaluation could provide unique insights into the performance of residents in training. However, reports of resident resistance to peer evaluation because of confidentiality issues and the possible impact on their working relationships raised concerns about the acceptability and utility of peer evaluation in graduate medical education. The literature suggests that peers are able to reliably assess communication, interpersonal skills, and professionalism and provide input that may differ from faculty evaluations. This study assessed the attitudes of internal medicine residents 1 year after the implementation of a peer-evaluation system. METHODS: During the 2005-2006 academic year, we conducted an anonymous survey of the 168 residents in the Internal Medicine Residency Program at the Mayo Clinic, Rochester, Minnesota. Contingency table analysis was used to compare the response patterns of the groups. RESULTS: The response rate was 61% (103/168 residents) and it did not differ by year of training. Most residents (74/103; 72%) felt that peers could provide valuable feedback. Eighty percent of residents (82/103) felt the feedback was important for their professional development and 84% (86/102) agreed that peers observe behaviors not seen by attending faculty. CONCLUSIONS: The results of this study suggest that internal medicine residents provide unique assessment of their peers and provide feedback they consider important for their professional development. More importantly, the results support the role of peer evaluation in the assessment of the competencies of professionalism and interpersonal and communication skills.

A multi-institutional survey of internal medicine residents' learning habits.

BACKGROUND: Resident physicians are expected to demonstrate medical knowledge. However, little is known about the residents' reading habits and learning preferences. AIM: To assess residents' reading habits and preferred educational resources. METHODS: Residents at five internal medicine training programs were surveyed regarding their reading and learning habits and preferences. RESULTS: The majority (77.7%) of residents reported reading less than 7 h a week. Most residents (81.4%) read in response to patient care encounters. The preferred educational format was electronic; 94.6% of residents cited UpToDate as the most effective resource for knowledge acquisition, and 88.9% of residents reported that UpToDate was their first choice for answering clinical questions. CONCLUSIONS: Residents spent little time reading and sought knowledge primarily from electronic resources. Most residents read in the context of patient care. Future research should focus on strategies for helping resident physicians learn in the electronic age.

An outbreak of Mycobacterium chelonae infections in tattoos.

Nontuberculous mycobacteria infections may occur after cutaneous procedures. Review of the medical records of patients who developed a rash within a tattoo revealed 6 patients with skin infections caused by Mycobacterium chelonae after receiving tattoos by one artist at a single tattoo establishment. The interval between tattoo placement and the skin findings was 1 to 2 weeks. All patients received alternate diagnoses before mycobacterial infection was identified. Skin findings included pink, red, or purple papules; papules with scale; pustules; granulomatous papules; and lichenoid papules and plaques. Histopathologic examination revealed granuloma, lymphohistiocytic infiltrate, or mixed inflammation; acid-fast bacilli stains produced negative results. Diagnosis was made by culture in 3 patients, histopathology in two patients, and clinical/epidemiologic association in one patient. The M chelonae isolates were clarithromycin susceptible, and the infections responded to macrolide antibiotics. Physicians should consider mycobacterial infections in patients with skin findings within a new tattoo.