Abbreviation Monday – HHS and KPD
We discussed a case of a 58 yo M who presents with altered mental status who was found to have HHS, with a glucose of 1018. His presentation is consistent with a subset of Type-II DM, known as Ketosis-Prone Diabetes (KPD). This subset often occurs later in life and a presentation of HHS/DKA can be […]
2 Cases of Pleural Effusion
Today we discussed 2 interesting cases of pleural effusions. 1) 56 yo Haitian man presented with DOE, LE edema and large right-sided pleural effusion. Thoracentesis showed a transudative effusion. His final diagnosis was systolic heart failure. Don’t forget, heart failure is known to lead to unilateral effusions on the right. No one knows why, it […]
Cerebral Vasculitis
Cerebral Vasculitis Review ARTHRITIS & RHEUMATISM Vol. 40, No. 7, July 1997, pp 1189-1201
Digital Ulcers + HIT
Today we went to the bedside to see a 49 yo F with limited scleroderma, who presented with digital ulcers. She initially presented with pain and ulceration that was refractory to supportive treatment at home, and shortly thereafter was admitted. The ulcer was most likely exacerbated by the presence of calcinosis at that digit. Treatment […]
Potpourri – CIN and elevated PTT
Today we had 2 fascinating cases in Resident Report. 1) A 51 yo F with HIV on HAART presenting originally for what was suspected to be gallstone pancreatitis. Pre-op evaluation for cholecystectomy was done, and a persistently elevated PTT was noted. How does one work up an elevated PTT? Differential diagnosis includes – Lupus anti-coagulant, […]
Cryptogenic Organizing Pneumonia
50 yo M with pmhx of RA (on methotrexate and prednisone chronically) and decubitus ulcers presenting with 2 weeks of cough and malaise. He was also found to be hypotensive and hypoxic. Infiltrates were seen on CXR and treatment for HCAP was initiated (had many exposures to healthcare settings in past). After several days of […]
Steroid Psychosis
A 57 y.o. F presenting with altered memory and difficulty reading which has been occurring over the past 2-3 months. On neurologic workup, a large left-sided temporal lobe lesion was noted on MRI. Craniotomy and resection were performed and patient was found to have a stage IV GBM (glioblastoma multiforme). She was treated with steroids […]
Thrombocytopenia
A 34 year-old Turkish man with PMHx of testicular CA (stage III and s/p BEP chemotherapy regimen and surgical excision), presents to BMC with a rash on arms and legs and bleeding m0uth. He was recently started on an H2 blocker for GERD-like symptoms. In a 5 day span, his platelet count dropped from > […]
Acute Pulmonary Embolus
A 49 y.o. M with HTN, HL and prior history of treated PE presents with dyspnea on exertion and CT-PA showing acute pulmonary embolus. Oxygen saturation was in the 80s on room air, but patient was normal heart rate and normal blood pressure. What are the next steps in management? Remember that after the patient’s […]
Septic Arthritis in a Patient with Rheumatoid Arthritis
77 y.o. F with past medical history of rheumatoid arthritis on etanercept (TNF-a inhibitor), DM, HTN presenting with whole body pain and fatigue consistent with flare of rheumatoid arthritis. Blood pressure was noted to be lower than normal. On exam, she was noted to have multiple painful small joints but also had a tender L […]