Unilateral recurrent pleural effusion
Today we discussed a 54 yo M p/w gradually worsening dyspnea on exertion, pleuritic chest pain and cough which is intermittently productive of greenish sputum. Denies fevers/ hemoptysis/ wt loss. Similar symptoms a month ago when he was admitted to a hospital in Cape Verde he was found to have right sided pleural effusion-> 1L of […]
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 […]
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 […]
RSV Pneumonia as a cause of dyspnea and hypoxia
A 43 y/o man w/ morbid obesity, OSA, diastolic heart failure and asthma presented with 3 days of worsening dyspnea on exertion, cough, subjective fevers and rhinorrhea. He had a low grade fever and hypoxia with normal lung sounds, significant LE edema and negative CXR. A JVP could not be appreciated due to body habitus. […]
Staphalococcus lugdunensis endocarditis in a patient with ESRD
A 71 y/o woman w/ ESRD on HD sent to ED for altered mental status during dialysis. On arrival patient was slightly confused and lethargic. Despite suspicion of dialysis related volume shifts causing brain hypoperfusion, the team astutely sent blood cultures due to high risk of infection in dialysis patients. These returned positive for coagulase […]
Septic Arthritis in a Patient with Rheumatoid Arthritis
77 y.o. F with past medical history of rheumatoid arthritis on etanercept (TNF-a inhibitor), DM, HTN presenting with whole body pain and fatigue consistent with flare of rheumatoid arthritis. Blood pressure was noted to be lower than normal. On exam, she was noted to have multiple painful small joints but also had a tender L […]
Recurrent C. difficile or Ulcerative Colitis flare?
A case of a 24yo woman with rapidly progressive ulcerative colitis and recurrent C. dif was presented. We reviewed how to diagnose C. dif (ELISA vs. PCR vs. culture) and available treatments, including a new antibiotic fidaxomicin. ISDA guidelines were also reviewed. Cost of various treatment regimens were mentioned: metronidazole course ~$100; vancomycin course ~$200; […]