Chronic bloody diarrhea in an HIV patient
The case we discussed today was that of a patient with HIV (on HAART) who presented with bloody diarrhea, abdominal pain and weight loss (25-40 lbs) over the past 4 months. Given that the differential diagnosis is broad in an immunodeficient patient, a CT abd/pelvis was obtained which showed segmental involvement of cecum through proximal sigmoid […]
Carotidynia and Fever
After the holiday weekend, people are back in action and solved/managed this complex case today. 53 yo F presenting with fevers, productive cough, nausea/vomiting/diarrhea with left neck/shoulder pain x 3 days. Tenderness was localized to area right below the angle of the jaw and overlying the carotid bifurcation. She was eventually found to have a mycotic […]
Peripheral eosinophilia with hypoxia
53 yo F smoker, presenting with acute onset hypoxia and found to have a 33% peripheral eosinophilia (abs eos 1.8). CXR had some increased interstitial markings and LLL ?atelectatic plates/vague infiltrate. CTPA was neg for PE but did show groud glass opacity alongwith tree in bud appearance in LUL. She was empirically started on PO […]
Bubble Trouble
This was a case of a 63 year-old man who presented with right upper extremity edema, erythema, and pain over 1 day duration, which included 2 large bullae on the forearm. Past medical history included hypertension, gout, and hyperlipidemia. Medications included furosemide, valsartan (previous angioedema reaction to lisinopril), allopurinol, and tamsulosin. Labs were normal. Initially […]
Just Simply an Upper Respiratory Infection?
We have a 30 year old woman with history of asthma, chronic pain syndrome s/p MVA with rib resection, and history of gonorrhea and HPV presenting with 2 days of persistent cough. With subjective fevers and chills, her concern has been coughing “fits”, as she describes it, with one to two episodes of post-tussive emesis. […]
Severe CAP- review of IDSA/ATS guidelines
48 yo F brought into ED for severe SOB with respiratory distress after 3 days of URI/flu like symptoms, SOB and cough. While in the ED she tires out and goes into respiratory failure needing intubation and mechanical ventilation. We reviewed the current combined IDSA/ATS guidelines for the follwing issues: Criteria for admission to the […]
Candidiasis threatening airway
We discussed a 48 yo M with HIV who was admitted for progressive worsening pain and swelling of his throat and neck with odynophagia over the preceding couple of mos but worse over the past 2 weeks. He was seen at an outside clinic 10 days prior to this for similar symptoms and treated with […]
Air where it’s not supposed to be
Today we talked about a 60yF (NH resident) with quadriplegia, dementia, IDDM, hx of staghorn calculus found to have emphysematous cytitis and pyelitis. – it is a rare but severe condition with high mortality without appropriate management – DM is a risk factor – determine management plan and prognosis by CT classification based on extension of gas into/ […]
Sepsis
A 49 y.o. man with HIV is admitted to the wards with a pneumonia. Shortly thereafter, he becomes profoundly hypotensive and confused. You have correctly identified septic shock in this patient. Here are some “light readings” about sepsis: Septic Shock (Lancet 2005 Jan 1-7;365(9453):63-78.) – Landmark review which defines “flavours” of sepsis along the continuum […]
Recurrent Episode of SOB
We discussed a 47 year old M with history of morbid obesity, non-ischemic CMY (EF 60%), pulmonary HTN, PE/DVTs, OSA on CPAP who presented with a 2 day history of shortness of breath. He reports chills, associated pleuritic chest pain as well as a productive cough of brownish sputum. Of note, one week prior to […]