JGIM New Section

With this issue, the Journal inaugurates a new section, Case Reports and Clinical Vignettes. We are particularly interested in clearly written cases that include a brief review of published relevant cases, a detailed description of the case, and a discussion of the case's distinctiveness. Other relevant considerations are contribution to published literature and implications for subsequent developments in clinical practice, teaching, or research. Emphasizing the main teaching points for General Internists has paramount importance. We welcome case reports, which illustrate a diagnostic dilemma or a unique management approach that either improves patient care or emphasizes an education goal.

In this issue, Oh et al.¹ describe a classic presentation of right-sided endocarditis in an injection drug user. The lack of clinical response and blood cultures revealing organisms usually found in the oral cavity led the clinicians to obtain the history of the patient having the habit of licking the needle prior to injection.

Malik et al.² describe an elderly male with an unusual manifestation of a relatively uncommon disease, myocarditis with severe left ventricular dysfunction in a patient with human granulocytic anaplasmosis (HGA). The careful examination of the peripheral smear revealing intracytoplasmic inclusions consistent with HGA led to the prompt treatment with doxycycline and complete recovery.

Roy et al.³ remind us of the superior mesenteric artery syndrome (also known as Wilkie's syndrome) as a rare cause of upper gastrointestinal obstruction. Because cardiac cachexia is a known complication of severe congestive heart failure, this case illustrates the importance of how a carefully obtained history of early satiety, nausea, and vomiting of partially digested food suggested the possibility of an upper gastrointestinal obstructive etiology.

The case presented by Nikolaidis et al.⁴ illustrates that the systematic search for a cause of hypoalbuminemia led to the diagnosis of protein-losing enteropathy. Furthermore, despite the absence of specific physical signs, the remote history of tuberculosis raised the suspicion of constrictive pericarditis.

What common thread links these cases? Each patient diagnosis required a meticulous approach—whether obtaining and interpreting a detailed history and physical exam (i.e., early satiety) or the judicious utilization of (i.e., the peripheral smear) and careful interpretation of (i.e., polymicrobial bacteremia) diagnostic tests, or systematically searching for a diagnosis (i.e., protein-losing enteropathy). Internists use these skills daily. Clinician-educators may use these cases for educational discussions.

Publishing a case vignette provides many advantages. The process of writing the vignette develops new skills. Writing and presenting a case report requires a more in-depth review of the literature, which broadens our knowledge of medicine. Writing and presenting a case report also clarifies the thinking process, organizes learning, enhances teaching, and possibly identifies areas of uncertainty. In addition, most academic medical centers require publication of scholarly activities in peer-reviewed journals as a criterion for promotion. We would like to remind clinician-educators of this unique opportunity and welcome your submissions. Many interesting patient cases are presented at the regional and national SGIM meetings.

We encourage your submissions and suggest that experienced clinicians and teachers review your manuscript prior to submission. Discussion with peers and experts helps identify unique teaching points and determines if the case is worth publishing. Cases that describe the most unusual manifestation of a rare disorder are probably best suited for a specialty journal. All submissions undergo a peer-review process. The Journal will publish an unstructured abstract of 150 words or less in the print version and a full version of up to 2,500 words in the online version. We look forward to your submissions and hope our comments and additional resources^5–11 are helpful as you submit your case vignette to the Journal.