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2015 Winners of the American College of Physicians – Delaware Chapter Medical Student Clinical Vignette Competition
Cheryl Jackson, MD, FACP
The Association of American Medical Colleges (AAMC) promotes training a diverse physician workforce that can make contributions to society beyond the conventional medical curriculum. Increasingly, U.S. medical schools are requiring students to undertake mentored projects during their medical training. Scholarly concentrations (SCs) give students opportunities to study subjects in-depth and complete an independent scholarly project, beyond the conventional medical curriculum.
Currently, medical students from 14 medical schools rotate through Christiana Care Health System’s Department of Medicine Fourth Year Student Program. Fourth year medical students are required
to submit a clinical vignette based on patients they have managed during their rotation. The students collaborate with their supervising Resident and Attending Physicians to chronicle a patient’s presentation, diagnosis, and subsequent treatment. They choose cases that may pose a diagnostic dilemma, present atypically, or illustrate
a teaching point. Ten of these case vignettes are selected for poster
College of Physicians (ACP) – Delaware Chapter. The winner of the Delaware Chapter competition is then sponsored to present at the National ACP Student Poster Competition.
Presented here are the original abstracts of the winners.
Grand Prize Winner Selected
for the National ACP Poster Competition
David Maniscalco, MS IV, Sidney Kimmel Medical College at Thomas Jefferson University; and David Michel, MD, Rheumatology, Christiana Care Health System, Newark, Del.
Introduction: Myositis, interstitial lung disease, mechanic’s hands, Raynaud’s phenomenon, fever, and polyarthritis characterize anti- synthetase syndrome. In this case, a 59-year-old African American male presented with signs and symptoms consistent with anti-
synthetase syndrome. This case is unique because anti-synthetase
in 0.5-8.4 cases per million. Of those cases, 30 percent of them result in anti-synthetase syndrome.
Case Description: A 59-year-old African American male with
a history of polyarthritis for many years presented to the hospital with hypotension and severe hypoxia. Over the past few months,
the patient had experienced recurrent pulmonary symptoms
thought to be due to pneumonia, for which he has been treated with antibiotics. His shortness of breath continued to worsen however, over the past couple of weeks he developed associated dizziness and lightheadedness. For the past two or three months he has noticed with getting up from a seated position. On the day of admission, the patient spiked a fever of 39°C. Physical examination was remarkable for synovitis in his MCP joints bilaterally and severe restricted range of motion in his shoulders and elbows. The strength exam for hip elevated creatine kinase, an elevated lactate dehydrogenase, and a transaminitis. A CT scan from two weeks prior demonstrated ground (ILD). An anti-extractable nuclear antigen was positive for
anti-Jo1 antibody. Rheumatoid factor and anti-CCP were also positive. X-rays of his hands did not show erosions. An MRI of
his bilateral thighs demonstrated active myositis. He was given a diagnosis of Jo-1 positive polymyositis with ILD with a clinical picture of anti-synthetase syndrome. The patient was started on Solu- Medrol and his symptoms improved. Azathioprine was suggested for long-term therapy.
Discussion: Even though anti-synthetase syndrome is a rare condition, this case highlights the importance of recognizing the characteristics of the syndrome early to reduce morbidity and mortality. The pieces of evidence from the history, physical exam, laboratory data, and imaging had to be compiled to make
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Del Med J | February 2016 | Vol. 88 | No. 2
