How to recognize TCA toxicity
We learnt how to recognize TCA toxicity via discussion of a case of a 54 yo F who was brought in unresponsive by EMS after her son called 911. She had a PMH of HCV, prior opioid abuse, depression who was on several medications including toprol, lisinopril, ASA, chlorthalidone, celexa, buspirone, mirtazipine, amitryptiline, MS Contin, klonipin […]
Chronic bloody diarrhea in an HIV patient
The case we discussed today was that of a patient with HIV (on HAART) who presented with bloody diarrhea, abdominal pain and weight loss (25-40 lbs) over the past 4 months. Given that the differential diagnosis is broad in an immunodeficient patient, a CT abd/pelvis was obtained which showed segmental involvement of cecum through proximal sigmoid […]
Carotidynia and Fever
After the holiday weekend, people are back in action and solved/managed this complex case today. 53 yo F presenting with fevers, productive cough, nausea/vomiting/diarrhea with left neck/shoulder pain x 3 days. Tenderness was localized to area right below the angle of the jaw and overlying the carotid bifurcation. She was eventually found to have a mycotic […]
That’s Rancid
This is a case of a 45 y/o incarcerated, actively smoking gentleman with severe GERD, seizure disorder due to EtOH withdrawal who presented with cough productive of gray, foul smelling (not only to patient but innocent bystanders as well) sputum for 2 weeks. CXR on admission revealed a right upper lobe cavitary lesion which was confirmed […]
Peripheral eosinophilia with hypoxia
53 yo F smoker, presenting with acute onset hypoxia and found to have a 33% peripheral eosinophilia (abs eos 1.8). CXR had some increased interstitial markings and LLL ?atelectatic plates/vague infiltrate. CTPA was neg for PE but did show groud glass opacity alongwith tree in bud appearance in LUL. She was empirically started on PO […]
Bubble Trouble
This was a case of a 63 year-old man who presented with right upper extremity edema, erythema, and pain over 1 day duration, which included 2 large bullae on the forearm. Past medical history included hypertension, gout, and hyperlipidemia. Medications included furosemide, valsartan (previous angioedema reaction to lisinopril), allopurinol, and tamsulosin. Labs were normal. Initially […]
Just Simply an Upper Respiratory Infection?
We have a 30 year old woman with history of asthma, chronic pain syndrome s/p MVA with rib resection, and history of gonorrhea and HPV presenting with 2 days of persistent cough. With subjective fevers and chills, her concern has been coughing “fits”, as she describes it, with one to two episodes of post-tussive emesis. […]
Hepatocellular Carcinoma
This was a 54 year-old man from Vietnam (immigrated to USA 20 years ago) with no past medical history, presenting with a week of epigastric pain. He also endorsed a 10-lb. weight loss over the past year, and had a significant smoking and alcohol abuse history, though stopped 1 year ago. He had remotely used […]
Dual dilemma
We discussed two cases today. Case#1: 61 yo F with HTN, DM brought in by daughter for acute onset of a single acute episode of visual hallucinations. She saw a girl (non existent) run across her living room and then saw lasagna (non existent) all over herself. Daughter was with her at this time and called […]
Classic Grave’s hyperthyroidism with anterior mediastinal mass
Stimulating discussion at Intern Report of a case of classic Grave’s hyperthyroidism. 21 yo F presenting with 40 lbs weight loss, palpitation, SOB/DOE, neck swelling, diarrhea, irregular menses for 6 months. On further evaluation was found to be hyperthyroid per labs and diagnosed with Grave’s disease (TSI/ thyroid stimulating immunoglobulins- elevated). She was also found to have […]