B-cell Lymphoma in the guise of Multiple Myeloma
A very intellectually stimulating discussion of a 54 yo homeless M presenting with acute on chronic R hip pain. More detailed history-taking reveals constitutional symptoms of progressive fatigue, fever with sweats, polyuria and constipation. On evaluation, serum calcium level was 18.8 (after correction), AKI and on MRI+CT multiple bone lesions (spine, R hip) and a splenic lesion as […]
Double teaming Mr. Bean
72 y/o F with recent diagnosis of pulmonary fibrosis secondary to ANCA-MPO + vasculititis presents with acute renal failure with dysmorphic RBCs on U/A. Pt was initially diagnosed with ANCA-MPO + glomerulonephritis and started on high dose steroids and immunosuppressants. Following biopsy, pt noted to have linear IgG deposits along basement membrane which alongside + anti-GBM assay also supported […]
Take a crack at Crack Lung!
A 55yo M presenting with cough, hemoptysis, shortness of breath and wheezing less than 24 hours after smoking “crack” or modified cocaine. The differential diagnosis included amongst many other things, Crack Lung or Acute Pulmonary Toxicity from inhalation (smoking/snorting) of cocaine. Learning points: – acute lung injury from cocaine happens usually with use within 48 hrs […]
Cardiac Tamponade in HIV patient
45 year old M with history of HIV/AIDS (CD4 150, VL 18, 000) presents with one week of worsening dyspnea on exertion. One month prior to admission, he was treated with Azithromycin for a productive cough and symptoms of URI. He reports that his baseline is walking on average 5 miles per day while he […]
Inferior MI with RV infarct
A 68 yo M with ESRD (on HD) brought in by EMS after a syncopal event at home. He was found to be bradycardic (30s) in junctional rhythm with hypotension and eventually found to have inferior ST elevation with reciprocal changes. We talked about how to recognize an RV infarct in the setting of inferior STEMI by using; if […]
A variation of Lemierre’s syndrome ?
We discussed a 26 yo M with active IVDU who was admitted for left axillary abscess with surrounding acute deep vein thrombosis/thrombophlebitis alongwith multiple septic emboli (some with cavities) in his lungs. Discussion was focused on differential diagnosis for such a presentation and then management. Lemierre’s syndrome was originally described as oropharyngeal infection (mostly with Fusobacterium necrophorum ) […]
I’ll Take Electrolyte Abnormalities for $100…
Our 52 year old M with history of CAD s/p LAD stent, HIV/AIDS (most recent CD4 291, VL 199K), St III CKD, HTN, DM, cocaine use presented with 2 days of lightheadedness secondary to hypoglycemic episodes. He initially endorsed decreased PO intake with skipping meals as well as feeling more fatigued and confused. Furthermore, he […]
Who is eating the red cells?
29 yo F with SCC presenting with a Hct of 13 which did not budge after transfusion and was diagnosed with a rare hematologic complication called Hyperhemolysis Syndrome. Key points to know about this are: – the post-transfusion Hct may be unchanged or even lower than pre-transfusion numbers – mechanisms implicated are: ineffective erythropoiesis, activation of […]
The Case of Monoarticular Pain
Our 67 year old woman with an extensive medical history including morbid obesity, coronary artery disease s/p MI, uncontrolled Type II DM (recent A1c 10.2%) with associated neuropathy and retinopathy, CRI, OA, DJD s/p left total knee replacement ’01 is presenting with sudden onset of left ankle pain over the course of the day. She […]
My Bowels Are Misbehaving
Today’s discussion focused on a 54 year old woman with hypertension and chronic pelvic pain s/p TAH/BSO presenting with lower abdominal cramping with associated bloody diarrhea. Pertinent findings were explored, including risk factors and dietary regimen to recurrence of her symptoms or review of constitutional symptoms. The case continues to where she recalls being able […]