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 […]
How stable is unstable?
50 yo F with NSTEMI (s/p PCI stents, about 4 years ago) admitted with unstable angina (UA), TIMI risk score of 3 (intermediate risk) with persistent angina despite aggressive medical therapy meeting criteria for early invasive management with cardiac catheterization. Definition: Angina at rest or new/worsening angina with no elevation of cardiac enzymes. Goals of discussion: […]
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, […]
Mosquito agitato
An 87 yo M brought in by son for complaints of generalized weakness/ malaise with intermittent “shaking” for 2-3 weeks prior to admission with history of returning from Liberia (West Africa) about 7 days ago after visiting family there. Labs notable for anemia with hyperbilirubinemia/ mild hemolysis with mild liver dysfunction and postive blood smears […]
Acute sarcoidosis/ Lofgren’s syndrome
A few weeks ago, a young patient (24yo) was admitted to our hospital with complaints of bilateral ankle pain, swelling and redness or “periarthritis” for 1 day with no other systemic symptoms. On ankle exam, was found to have pain with active movements of the ankle but none with passive. +tenderness along posterior tibialis and peroneus tendons […]
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 […]
Headache – Is it different if the patient has HIV?
A case of a 34yow from the Dominican Republic with a hx of HIV (not on ART) and G6PD who presented with 3 months of frontal/top of the head 10/10 throbbing headaches that kept her awake at night, woke her up in the morning and lasted through the day. Also with 3 months of rhinorrhea […]
Tongue Ulcers
A case of a 38yom with hx HIV (CD4 234, ran out of ART 1 month prior) presented with 2 weeks of a painful ulceration on his tongue and painful bilateral neck swelling (lymphadenopathy with necrotic nodes on CT). The differential diagnosis for oropharyngeal ulcerations was discussed as well as how to diagnose and treat […]
Who Should be Ruled out for TB?
Ever asked yourself whether someone should be ruled out for TB and weren’t sure how to answer the question? Here are a couple of articles that help answer the question. TB risk factors, positive PPD, fever, upper lobe infiltrate are all positive predictors of TB infection. Shortness of breath and crackles were negative predictors. http://archinte.ama-assn.org/cgi/reprint/160/16/2471 – […]
Pancreatitis with no CBD dilitation
52 y/o M with HCV presents with RUQ & epigastric abdominal pain with associated nausea, vomitting and inability to tolerate PO. No EtOH use. Exam significant for volume depletion, icterus and RUQ tendermess/epigastric tenderness with negative Murphy’s sign & no shifting dullnes. Labs reveal hypochloremia, volume contraction, Transaminitis in 20o0s. TBilil 111, DBili 9, AlkP […]