December 31, 2023
IgG Subclass Deficiency
- Russell M. Petrak MD
- Review
Immunoglobulin G subclass deficiency has been diagnosed in 25% of patients presenting with recurrent infections. Similar to other primary immunodeficiencies, it is commonly overlooked or misdiagnosed. The diagnosis includes documentation of a decreased level of one or more subclasses in conjunction with an inadequate response to a vaccine challenge. Understanding the specific actions of the four subclasses allows the clinician to direct the evaluation and define a treatment program. Several subclass deficiencies are also associated with other disease states. Diagnosis of this entity will limit patient morbidity and allow for more rapid identification of other potentially life-altering illnesses.
A Man with Chest Pain and an Abnormal Sternal CT
- Paul Brune
- Case Reports
A middle-aged man presented with sternal pain that progressed to the development of a sternal mass over the next few months. The subsequent workup and treatment are outlined, and the differential diagnosis is discussed.
Enigmatic CNS Lupus Vasculitis: A Heuristic Approach
- Christopher Szewczyk
- Case Reports
Systemic lupus erythematosus is an autoimmune disease affecting all organs of the body. It has a higher incidence in women and can affect the central nervous system (CNS) in 10% to 20% of cases. Any structure in the CNS can be involved, resulting in a varied and often complex symptomatology. CNS lupus vasculitis is an even rarer manifestation characterized by small vessel inflammation that can result in vessel thrombosis and necrosis. We present the case of a 31-year-old woman with a history of systemic lupus erythematosus and Sjögren’s syndrome who was treated at our institution for an acute exacerbation of lupus complicated by CNS lupus vasculitis. This case was particularly challenging due to concurrent bacteremia and a travel history that broadened the differential diagnosis widely, thus requiring our input as infectious disease consultants. CNS lupus vasculitis is a diagnosis of exclusion that requires a high level of clinical suspicion to arrive at a prompt diagnosis paired with aggressive management to guarantee good outcomes. In this report, we share our stepwise approach to this challenging case in a didactic manner to benefit trainees and independent infectious diseases providers who may encounter similar clinical scenarios in their practice.
Private Practice Infectious Disease: Metro Infectious Disease Consultants
- Russell Petrak, M.D.
- Original Article
Despite the stimulating nature of infectious diseases (ID), fellowship programs have failed, on a yearly basis, to fill multiple positions. In addition, numerous entities have published information showing that infectious disease physicians are poorly reimbursed compared to their colleagues in other specialties and are likely to feel overwhelmed. To assess the status of our ID group and define opportunities for improvement, Metro Infectious Disease Consultants (MIDC) conducted an internal audit. Eighty-nine percent of physician employees and 94% of partners were satisfied or very satisfied with MIDC. In addition, based on a Medscape survey, MIDC employees received financial compensation that was 18% greater and partners 235% greater than the average for all ID physicians. A private practice model of infectious diseases is a viable, lucrative, and professionally stimulating option to other ID models. This allows for enhanced lifestyle flexibility and should be viewed by potential ID applicants as a realistic and widely available option to practice this dynamic specialty.
Town or Gown? ID Needs Both
- John Segreti
- Editorial
In 1978, Robert G. Petersdorf, MD, made the statement that the war against infectious diseases had been won and that additional ID specialists were no longer necessary. He went on to say that if additional specialists were trained, they would end up culturing one another. He continued that: Infectious disease is destined to function best as an academic specialty whose trainees should pursue careers primarily as investigators. The number of clinicians leaving training should be reduced and not further glut the marketplace; they should be based in academic divisions and devote their clinical time and effort to the care of complex referral and to indigent patients.
