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 […]
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 […]
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 […]
Necrotizing Fasciitis
58 y.o. M who presented to outside hospital with cellulitic-appearing rash on LLE with significant pain and blistering. Transferred to BMC for further evaluation for concern about necrotizing fasciitis. Following evaluation by Surgery service and ID service, it was thought that this patient was unlikely to have necrotizing fasciitis. Please see links below for more […]
Erythrasma
This was today’s image of the day. I will spare you from looking at that photo again. Erythrasma is an infection caused by Corynebacterium minutissimum that often can be mistaken for Candida or other fungal infections because of it’s location in skin folds. Here is a great link from Consultant (a primary care journal) which […]
Neutropenic Fever and HIV
Today’s case was a 41 y.o. F with AIDS not on HAART who presented with a suspected groin abscess and also was found to have a low ANC (580). In the past she has been found to be neutropenic. Do you treat a neutropenic fever differently in HIV? We discussed neutropenic fever treatment in general, and […]