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 […]
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 […]