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Clinicians must be prepared to identify tobacco use among patients and implement behavioral interventions to help patients quit. By understanding behavioral interventions and pharmacologic options, clinicians can design an optimal quit plan for each patient. This article reviews foundations of tobacco cessation, pharmacotherapy updates, and the emergence of e-cigarettes as desirable cessation tools for patients.

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Immune thrombocytopenic purpura (ITP) has been described following both coronavirus disease 2019 (COVID-19) infection and COVID-19 vaccination. ITP is a challenging diagnosis of exclusion, and the pathophysiology of these complications is not well understood but believed to be autoimmune in nature. We describe a severe case of ITP following COVID-19 infection in a patient without a history of hematologic or autoimmune disease and his subsequent uneventful course following COVID-19 vaccination. The current Centers for Disease Control and Prevention (CDC) advisory does not identify a history of ITP as a contraindication to COVID-19 vaccination. We compare our study, which describes an uneventful COVID-19 vaccination course with cases that have described recurrences and relapses of ITP following both COVID-19 infection and COVID-19 vaccination. These reports suggest that the placement of some patients into a unique subset among all patients with ITP may be prudent with regard to future COVID-19 vaccination. Through a literature review, we discuss a broader picture of how COVID-19 infection-associated ITP may differ from COVID-19 mRNA vaccination-associated ITP in its demographics, etiology, and outcomes.

The introduction of mRNA-based COVID-19 vaccinations has been useful in decreasing risks of severe illness with COVID-19 infection. Cardiac tamponade is a rare cardiovascular emergency that has been observed following both mRNA-based COVID-19 vaccinations and COVID-19 infections. We report the first case of a hemorrhagic pericardial effusion with cardiac tamponade in a 52-year-old woman occurring one week following the second dose of the BNT162b2 (BioNTech/Pfizer) SARS-CoV-2 vaccination. The time sequence in this case report correlates with reports submitted to the Vaccine Adverse Event Reporting System (VAERS), which indicates that cases of pericarditis following mRNA vaccination most commonly occur within 1-2 weeks following the second dose of vaccination.