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Adult Immunization Center

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Hemoptysis in a Previously Healthy Young Man

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Clinical Topics

Hard Purple Nodules: Your Dx?

Acromegaly was diagnosed in a 36-year-old woman who presented with loss of vision in the right eye that had initially involved the peripheral field. MRI scans of the brain revealed a 6 × 6 × 4-cm sellar mass with suprasellar and parasellar extension encasing the right cavernous sinus and carotid artery.

A. Excess growth hormone production from the pituitary gland as a result of a functional adenoma is the most common cause.

B. It remains undiagnosed for up to 10 years on average.

C. The diagnostic test of choice is an oral glucose tolerance test.

D. End-organ manifestations (eg, arthropathy, cranial nerve palsies, diabetes) contribute to overall mortality increase.

Acromegaly was diagnosed in a 36-year-old woman who presented with loss of vision in the right eye that had initially involved the peripheral field. Which statement about acromegaly is NOT true?

Acromegaly: A Pop Quiz

Several months earlier, this asymptomatic, pigmented, hard nodule arose on the upper arm of a 37-year-old woman.

Do you suspect this hard nodule to be a melanoma?

Melanoma-or Look-Alike?

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

White Knuckles

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2½ weeks earlier, when he was hit in the face by a baseball.

Is this lesion the result of an injury, as the boy’s mother suspected, or something else?

Scaly Plaque on the Nose

The CDC’s Advisory Committee on Immunization Practices (ACIP) voted 14-0, with one abstention, to expand its guidance to recommend 

respiratory syncytial virus (RSV) vaccination

 for adults aged 50 to 59 years who are at increased risk for severe RSV‑associated lower respiratory tract disease (LRTD).

"I don't think I can say it enough, but [we need] more studies in moderate-to-severe immunocompromised patients who are at highest risk for RSV disease," ACIP member Mini Kamboj, MD, of Weill Cornell Medical College, in New York City, said after she voted for the recommendation. This is "a call to action," Dr Kamboj said in the April 16, 2025, meeting.

Wednesday’s action builds on ACIP’s June 2024 vote to recommend RSV vaccination for adults aged 60–74 years at increased risk and all adults aged 75 years and older.

According to the CDC, RSV causes an estimated 15 000–20 000 hospitalizations annually among US adults aged 50–59 years, with the highest risk observed in those with underlying conditions such as obesity, cardiovascular disease, diabetes, COPD, and asthma. A separate systematic review estimated approximately 42 000 hospitalizations each year in adults aged 50–64 years, adjusted for under‑detection.

Three RSV vaccines are currently approved in the US for adults aged 60 years and older: 

 (messenger RNA vaccine). Arexvy is additionally approved for use in adults aged 50 to 59 years who have underlying medical conditions that increase their risk for severe RSV disease. Abrysvo also is approved for prevention of LRTD caused by RSV in 

 at 32 to 36 weeks' gestational age for the prevention of LRTD caused by RSV in infants from birth through 6 months. Moderna has submitted an application to the FDA to extend mResVax to adults aged 18 to 59 years, with a decision expected by June 12, 2025.

“With its vote to expand adult RSV vaccination recommendations, ACIP has taken an important step toward protecting individuals aged 50 to 59 who have underlying medical conditions that increase their risk for severe RSV illness,” Alejandro Cane, Vice President, Vaccines and Antivirals US Medical Lead, Pfizer, said in a press release.

 “We are proud that ABRYSVO has the broadest indication among RSV vaccines, covering older adults, adults 18 and older at heightened risk of severe disease, and pregnant women to help protect infants.”

Tony Wood, chief scientific officer at GSK, added in a press release, “We are pleased with ACIP's recommendation to expand the benefits of RSV [immunization] to more than 13 million adults aged 50-59 who are at increased risk for the severe consequences of this virus.”

The ACIP also voted unanimously to recommend that GSK's pentavalent MenABCWY 

 meningococcal vaccine "may be used when both MenACWY and MenB are indicated at the same visit." The recommendation would apply to "healthy persons ages 16 to 23 years (routine schedule) when shared clinical decision-making favors administration of MenB vaccine; and persons aged 10 years and older who are at increased risk for meningococcal disease (eg, because of persistent complement deficiencies, complement inhibitor use, or functional or anatomic asplenia)." Committee members approved a similar recommendation for the Vaccines For Children program.

ACIP recommendations are not considered final until they are published in the 

1. Advisory Committee on Immunization Practices. ACIP Live Stream April 16, 2025. YouTube. April 16, 2025. Accessed April 17, 2025. 

2. Halsey G. ACIP revises recommendation for adult RSV vaccination. 

https://www.patientcareonline.com/view/acip-revises-recommendation-for-adult-rsv-vaccination

3. ACIP votes to expand recommendation for Pfizer's RSV vaccine ABRYSVO® to include adults aged 50 to 59 at increased risk of disease. Pfizer. News release. April 16, 2025. Accessed April 17, 2025. 

https://www.pfizer.com/news/press-release/press-release-detail/acip-votes-expand-recommendation-pfizers-rsv-vaccine

The CDC advisory committee also endorsed GSK's pentavalent meningococcal vaccine. 

ACIP Expands RSV Vaccine Recommendation to At‑Risk Adults Aged 50–59 Years

Clare Hawkins, MD

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