Eosinophils Everywhere!
Resident report reviewed an ongoing case of a 37yo Guatemalan man who presented initially with 3 weeks of malaise, fatigue, subjective fevers and muscle aches found to have LLL infiltrate and small pleural effusion. He was sent home from the ER with a Z-pack. He represented to the ER 3 days later with no resolution […]
Why are my toes blue?
A case of a 40 year old woman from Honduras presenting with Raynaud’s disease to Rheumatology clinic – cyanosis and ulceration of her left foot digits. She had atypical features of primary Raynaud’s – age > 30, asymmetric digit cyanosis, sclerodactyly/hand skin thickening – which prompted further work-up. She was found to have high titer […]
Esophageal Squamous Cell Carcinoma
Today’s Resident Report featured a patient with a new diagnosis of esophageal squamous cell carcinoma. The patient is a 61 y.o. Kenyan man with no prior medical history presenting with progressive symptoms of dysphagia, oodynophagia and new GERD-like symptoms. Clinical Pearl: New onset of GERD in the elderly should be worked up with upper endoscopy. […]
Don’t Fall for This One!
This was a case of a 97 y/o male who was admitted with a diagnosis of mechanical fall. More than 30% of adults over the age of 65 suffer a fall and 10% of these cases result in serious life-altering injuries. Therefore, we discussed the importance of fall prevention, highlighting Vit D supplementation and its pathophysiologic relationship […]
Legionella Pneumonia
The Heme/Onc team made a great diagnosis of Legionella pneumonia in a neutropenic patient undergoing chemotherapy for nasopharyngeal squamous cell carcinoma. Please remember to consider Legionella when you are working up your patients for causes of nosocomial pneumonia. It’s not as rare as you think. An article from CID (Clinical Infectious Disease) discussing the changing […]
TB or not TB?
27 y/o Egyptian Male presents with cc of progressive hemoptysis and weight loss while on treatment for TB. Imaging reveals a large LLL cavitary lesion with multiple heterogeneous peripheral cystic/cavitary lesions. What’s going on? Key topics covered: 1)Differential for hemoptysis; 2) treatment regimen in TB, MDR-TB & XDR-TB; 3) cystic versus cavitary lesions Current Concepts […]
Syphilis
A patient on HAC wards came in with subjective complaints of cognitive decline. Records from the patient’s PCP showed she had a positive FTA-Abs which was untreated. After a comprehensive physical exam and LP, it was determined that this patient had latent syphilis. Points discussed: Epidemiology of syphilis – South End in Boston has a […]
Multiple Problems
67 y/o M presents with back pain, generalized fatigue, anorexia, nausea & vomiting. Exam reveals: altered mental status and profound volume depletion. Labs reveal normocytic anemia, acute renal failure, hypokalemia 2.9, hypercalcemia to 14 and hypergammaglobinemia. Imaging reveals lytic lesions in T10. Pt on initial presentation was noted to have severe hypercalcemia with resultant diabetes […]
Thyrotoxicosis presenting as Heart Failure
61 y/o Male who was treating a “fast HR” for years with Chinese herbals presents with history of increasing lower extremity edema and difficulty breathing. History significant for NYHA Class II/III symptoms and weight loss of 30lbs. Exam significant for cachexia, lid lag, pulmonary congestion, tachycardia, elevated JVP, possible pulsatile liver, pitting edema extending up […]
Bronchiectasis
64 y.o. M with medical history significant for pulmonary T.B. (treated in the 1980s) presenting with hemoptysis, but without other symptoms consistent with reactivation T.B. Discussed other causes of hemoptysis, particularly bronchiectasis, which was prominent in the patient’s imaging. See the links below: Bronchiectasis Powerpoint from today Bronchiectasis Review – Chest. 2008 Oct;134(4):815-23. Asbestosis Review […]