Eosinophilic Granulomatosis With Polyangiitis Diagnosed in an Elderly Female After the Second Dose of mRNA Vaccine Against COVID-19

Eosinophilic granulomatosis with polyangiitis is a type of medium and small-vessel vasculitis that is characterized by asthma, polyneuropathy, peripheral eosinophilia, rhinosinusitis, and other organ involvement, such as the lung and skin. Here, we present an interesting case of eosinophilic granulomatosis with polyangiitis after the mRNA-1273 (Moderna) vaccine against coronavirus disease 2019 (COVID-19). The patient presented with progressive weakness and paresthesia in the upper and lower extremities. She was found to have peripheral eosinophilia and elevated anti-myeloperoxidase antibodies. Nerve and muscle biopsies showed focal vasculitis with infiltration by eosinophils. The patient was started on steroids and a steroid-sparing agent shortly after that and had marked improvement of her symptoms

An Unusual Presentation of Immunoglobulin G4-Related Disease (IgG4-RD) Causing Subglottic Stenosis

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that is known to involve multiple organs and was first described as an entity in 2003. It is characterized by lesions with a dense lymphoplasmacytic infiltrate, IgG4-positive plasma cells, storiform fibrosis, and frequently elevated serum IgG4 levels. Organs that are commonly involved include the pancreas, biliary tree, salivary glands, periorbital tissues, kidneys, retroperitoneum, lungs, pleura, thyroid, aorta, and lymph nodes. Rarer manifestations of IgG4-RD include central nervous system (CNS) involvement, prostatitis, mastitis, midline destructive disease, and nasopharyngeal disease. In this report, we discuss an atypical case of a young woman with laryngeal subglottic involvement leading to stenosis and airway obstruction, which was ultimately successfully managed with systemic immunosuppression

A Rare Presentation of Zoledronate-Induced Systemic Inflammatory Response

Zoledronic acid is a bisphosphonate commonly used to treat various conditions involving bone loss. While it is generally well-tolerated, the occurrence of severe inflammatory reactions is rare. We present the case of an 82-year-old female who developed a severe immune reaction, including weakness and tenderness in her upper and lower extremities, following a single dose of zoledronic acid infusion for the treatment of osteoporosis. The onset of symptoms occurred one week after the infusion and persisted, progressively worsening over time, leading to functional impairment and the need for a walker for ambulation. Laboratory studies revealed an elevated erythrocyte sedimentation rate while other autoimmune markers were within normal limits. Differential diagnosis included an adverse reaction to zoledronic acid or underlying polymyalgia rheumatica. The patient showed significant improvement with a prednisone taper, suggesting an immune-mediated response. This case highlights the importance of considering severe immune reactions as a potential side effect of zoledronic acid and emphasizes the need for further research to better understand the underlying mechanisms and optimize patient management

Musculoskeletal ultrasound training for the internal medicine resident: Development and assessment of a teaching curriculum for elective rotation.

NEEDS AND OBJECTIVES: Ultrasound has become increasingly utilized throughout internal medicine and its subspecialties. Musculoskeletal ultrasound is a vital tool for assessing patients with tendon and joint abnormalities, and is employed for diagnostic as well as therapeutic purposes. Internal medicine residents would benefit from using musculoskeletal ultrasound as musculoskeletal problems are among the most frequently encountered complaints in ambulatory clinic. Formal training in musculoskeletal ultrasound is largely absent from internal medicine residency programs. We sought to establish an elective rotation in musculoskeletal ultrasound for the internal medicine resident, and develop an effective teaching curriculum that could be easily implemented at other internal medicine residencies. SETTING AND PARTICIPANTS: The course took place as part of a month-long elective rotation at an outpatient rheumatology musculoskeletal ultrasound clinic. A senior staff rheumatologist who was board certified in musculoskeletal ultrasound by the American College of Rheumatology assisted with curriculum development and led the course. Internal medicine residents from a large academic teaching hospital and from all training levels took part, including some interested in pursuing rheumatology fellowship training. DESCRIPTION: Goals and objectives were created to reflect the six core competencies for residents in graduate medical education. A structured curriculum was developed using units with modules that incorporated book chapters, online videos, and hands-on workshops with the ultrasound, which were broken down by joint system. Residents spent time reading, observing, and practicing with the ultrasound before performing supervised examinations and interventions on their own. EVALUATION: A pre- and post-test was administered to the residents. It consisted of multiple choice questions and ultrasound-captured images covering principles of ultrasound as well as basic musculoskeletal anatomy and pathology. An opportunity to provide course feedback was given on the posttest evaluation. DISCUSSION/REFLECTION/LESSONS LEARNED: Feedback was very positive from the six internal medicine residents who took part in the course, and pre- to post-test scores improved by over fifty percent. Residents felt the course was a good learning experience and that its strengths were a clear curriculum, the amount of teaching and the opportunity to become comfortable using ultrasound to both understand musculoskeletal anatomy and pathology as well as perform joint aspirations and injections. Overall, everyone indicated that the course had very good utility for the internal medicine resident. Based on our positive results and feedback, we felt the course and its curriculum were an effective means to teach musculoskeletal ultrasound to internal medicine residents

Musculoskeletal ultrasound training for the internal medicine resident: Development and assessment of a teaching curriculum for elective rotation

NEEDS AND OBJECTIVES: Ultrasound has become increasingly utilized throughout internal medicine and its subspecialties. Musculoskeletal ultrasound is a vital tool for assessing patients with tendon and joint abnormalities, and is employed for diagnostic as well as therapeutic purposes. Internal medicine residents would benefit from using musculoskeletal ultrasound as musculoskeletal problems are among the most frequently encountered complaints in ambulatory clinic. Formal training in musculoskeletal ultrasound is largely absent from internal medicine residency programs. We sought to establish an elective rotation in musculoskeletal ultrasound for the internal medicine resident, and develop an effective teaching curriculum that could be easily implemented at other internal medicine residencies. SETTING AND PARTICIPANTS: The course took place as part of a month-long elective rotation at an outpatient rheumatology musculoskeletal ultrasound clinic. A senior staff rheumatologist who was board certified in musculoskeletal ultrasound by the American College of Rheumatology assisted with curriculum development and led the course. Internal medicine residents from a large academic teaching hospital and from all training levels took part, including some interested in pursuing rheumatology fellowship training. DESCRIPTION: Goals and objectives were created to reflect the six core competencies for residents in graduate medical education. A structured curriculum was developed using units with modules that incorporated book chapters, online videos, and hands-on workshops with the ultrasound, which were broken down by joint system. Residents spent time reading, observing, and practicing with the ultrasound before performing supervised examinations and interventions on their own. EVALUATION: A pre- and post-test was administered to the residents. It consisted of multiple choice questions and ultrasound-captured images covering principles of ultrasound as well as basic musculoskeletal anatomy and pathology. An opportunity to provide course feedback was given on the posttest evaluation. DISCUSSION/REFLECTION/LESSONS LEARNED: Feedback was very positive from the six internal medicine residents who took part in the course, and pre- to post-test scores improved by over fifty percent. Residents felt the course was a good learning experience and that its strengths were a clear curriculum, the amount of teaching and the opportunity to become comfortable using ultrasound to both understand musculoskeletal anatomy and pathology as well as perform joint aspirations and injections. Overall, everyone indicated that the course had very good utility for the internal medicine resident. Based on our positive results and feedback, we felt the course and its curriculum were an effective means to teach musculoskeletal ultrasound to internal medicine residents