Abd Pain in Peritoneal Dialysis: So special?
59 y/o M with hx of ESRD on PD & recurrent pancreatitis of unknown etiology presents with cc of abdominal pain. What diagnosis should you always be considering? How do you assess the peritoneal effluent (diasylate, not ascitic fluid)? What is the best mode of treatment: intraperitoneal or intravenous? Is there an association or increased […]
Cardiac Tamponade in HIV patient
45 year old M with history of HIV/AIDS (CD4 150, VL 18, 000) presents with one week of worsening dyspnea on exertion. One month prior to admission, he was treated with Azithromycin for a productive cough and symptoms of URI. He reports that his baseline is walking on average 5 miles per day while he […]
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 […]
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 […]
Catheter-Associated UTI
Today’s case was an 80 y.o. M with chronic foley catheter admitted with signs of sepsis, with a dirty UA. How do we go about diagnosing and treating catheter-associated UTI? IDSA 2009 Guideines for CA-UTI CA-UTI and the implications of the Medicare rule change (i.e. no Medicare payment for tx of CA-UTI)
Septic Joints
A couple of cases on the wards currently of septic prosthetic joints – one patient with an infected hip and one patient with an infected knee. Monoarticular arthritis has a different differential diagnosis than migratory arthritis. Diagnosis of a septic joint is difficult to make based on symptoms and physical exam (see the JAMA article […]
Lyme Carditis
Today’s Resident Report featured a fascinating case of Lyme carditis. Cardiac Implications of Lyme Disease – International Journal of Cardiology Volume 129, Issue 1, 16 September 2008, Pages 15-21 2006 IDSA Guidelines for Treatment of Lyme Disease – Clinical Infectious Diseases 2006; 43:1089–134 Did you know that there is a huge controversy in treatment of chronic […]