Is Difficult to Ambulate
The discussion today involved a 54 year old gentleman with a history of polysubstance IV abuse, HTN, and bilateral degenerative changes of the knee s/p left knee replacement who presented with 1.5 weeks of RLE pain of burning nature. Along with worsening erythema and swelling, the gentleman also had difficulty with ambulation. What initially was thought […]
Legionella masquerade
We discussed a 69yo M with HIV (CD4 230, not on HAART), HCV admitted for non specific symptoms of primarily RUQ and midepigastric dull abd pain with malaise, decreased PO, dry cough for 3 days. Initial though process on presentation was GI pathology but CXR showed RLL PNA. Team sent out Legionella urine Ag which […]
New emerging liver infection
71 yoM , resident of the US with recent trip to Cape Verde, is brought in directly from the airport for complaints of early satiety, weight loss and abdominal distension which started prior to his leaving. He was found to have large multi-loculated invasive abscesses in the left and caudate lobes of his liver which grew […]
That’s Tough to Swallow!
How do we go about exploring the world of dysphagia? One start was to review a case of a 49 year old gentleman with a history of polysubstance abuse (heroin, alcohol) who presented with several days of dysphagia with more difficulty with solids. Further investigation revealed that he had no trouble initiating his swallowing, but […]
Acidemia in Short Bowel Syndrome
53 yM with hx of Protein C Deficiency (on LMWH), remote hx of mesenteric thrombosis and bowel resection (’81) admitted for severe mixed anion gap and non-anion gap acidosis (bicarb of 7 and ΔΔ <1). Teaching points: – estimate AG using albumin even though the measured AG appears normal- there may be an inapparent AG – calculate ΔΔ […]
Elderly Woman with Periumbilical Pain
Today’s case involved a 77 year old F with CAD s/p CABG 2008, atrial fibrillation, HTN, DMII who presented with 1 week of periumbilical pain with associated nausea and emesis. Additionally, she was found to have a monocytosis as well as pre-renal azotemia. Although a poor historian, residents were able to delve into potential differentials […]
Oligoarthritis in an HCV patient
– In addition to all other causes of arthritis, HCV related arthropathy should be on the differential diagnosis of any patient with chronic inflammatory arthritis and especially in patients with known HCV infection – Two distinct groups have been described in HCV related arthropathy ; RA-like arthritis (bilateral, symmetric, small joints) and Oligoarthritis (often associated […]
Bradycardia Bites in New England
55 y/o F presents with acute onset lightheadness usually worse when lying down at night and dyspnea on exertion for the last three days with a recent history of outdoor activity near the Cape and ticks on her cat! (less than 4 weeks ago) Pt admitted with HR of 36, BP 134 59 and afebrile. […]
The Saga of Ascites and Albumin
59 y/o M with HCV, ETOH and Cirrhosis readmitted from rehab with worsening ascites and renal function. Important questions that were discussed. Ascites: Pathophysiology of Ascites? The importance of splanchnic vasodilitation in circulatory dysfunction? Treatment options based on pathophysiology? How infection worsens splanchnic vasodiliation and thus ascites? Renal and Circulatory Dysfunction in Cirrhosis: Current Management and Future […]
Septic Joints
A couple of cases on the wards currently of septic prosthetic joints – one patient with an infected hip and one patient with an infected knee. Monoarticular arthritis has a different differential diagnosis than migratory arthritis. Diagnosis of a septic joint is difficult to make based on symptoms and physical exam (see the JAMA article […]