Necrotizing Fasciitis
58 y.o. M who presented to outside hospital with cellulitic-appearing rash on LLE with significant pain and blistering. Transferred to BMC for further evaluation for concern about necrotizing fasciitis. Following evaluation by Surgery service and ID service, it was thought that this patient was unlikely to have necrotizing fasciitis. Please see links below for more […]
Erythrasma
This was today’s image of the day. I will spare you from looking at that photo again. Erythrasma is an infection caused by Corynebacterium minutissimum that often can be mistaken for Candida or other fungal infections because of it’s location in skin folds. Here is a great link from Consultant (a primary care journal) which […]
Autoimmune Hepatitis
41 y.o. man presenting with new onset of jaundice. His labs, including high bilirubin were consistent with alcoholic hepatitis. However the patient vehemently denied being a heavy drinker. Serum ANA and anti-smooth muscle antibody both came back positive and the diagnosis of autoimmune hepatitis was entertained. Here are some links for your perusal: Review of […]
Thiazide-Induced Hyponatrémie
Where there are thiazides will there also be Hyponatremia? Today, this is not in question, but rather, where do you want to be when you have it. We have a French Female Flutist presenting to BMC via logan airport with a Na of 111. Teaching Points: Differential for Hypotonic Hyponatremia by volume status. Mechanism of Hyponatremia via Thiazide […]
Eosinophilia
Today’s resident report focused on the workup of peripheral eosinophilia and pulmonary infiltrates. The patient is a 41 yo F from Haiti presenting with repeated asthma exacerbations and 38% Eos on differential. Broad categories for the differential diagnosis are: Infectious (parasitic, fungal) Hematologic (hyper-eosinophil syndrome) Autoimmune (Churg-Strauss syndrome, eosinophilic pneumonia) Allergic Reaction/Hypersensitivity Reaction Here are […]
Neutropenic Fever and HIV
Today’s case was a 41 y.o. F with AIDS not on HAART who presented with a suspected groin abscess and also was found to have a low ANC (580). In the past she has been found to be neutropenic. Do you treat a neutropenic fever differently in HIV? We discussed neutropenic fever treatment in general, and […]
Syncope
First, I wanted to thank you guys for being so excellent at resident report and participating with such vigor….that is what we (the Chiefs) live for! the best predictor for a cardiac cause for syncope in a patient with suspected/certain heart disease is the presence of the underlying cardiac dx the best predictor for a cardiac cause […]
Palpable Purpura
Hi guys, this case involved a patient with palpable purpura who was found to have a small veessel vasculits. NEJM Review of Small Vessel Vasculitis
Acute Chest Syndrome/VOC
Today’s case dealt with a sickle cell crisis and treatment of acute chest syndrome, depending on its severity. Here is a wonderful review of sickle cell disease from the Lancet: Lancet 2010 376: 2018-2031 And here is a short review of acute chest syndrome from the Internal Medicine Journal: Intenal Medicine Journal 2010 40; 372-380
Pericarditis
What are treatments for acute pericarditis? The COPE Trial is a randomized, controlled trial which compared added colchicine to standard regimens of NSAIDs. Symptoms and incidence of recurrence were decreased compared to COPE Trial; Circulation. 2005; 112: 2012–2016.