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 […]
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. […]
Acute Onset of Lactic Acidosis
Here is a case of a 71 year old woman with a history of CAD s/p left carotid endarterectomy, pulmonary hypertension on tadalafil and Home O2 therapy, symptomatic cholelithiasis, HTN, DM II (A1c 7.3%) presenting with two days of right sided flank pain. Described as sharp and constant, it radiates up to lower scapula border […]
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 […]
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 […]
Blackout in a can
A 19 yo M presenting with non specific complaints of nausea/ vomiting/ abdominal pain and diffuse bodyache and foind to have an AG metabolic and respiratory acidosis with lactate of 13.2 and pH of 7.04. We went through the differential diagnosis of above which included methanol/ ethylene glycol/ isopropyl alcohol amongst others. This patient had […]
Take a crack at Crack Lung!
A 55yo M presenting with cough, hemoptysis, shortness of breath and wheezing less than 24 hours after smoking “crack” or modified cocaine. The differential diagnosis included amongst many other things, Crack Lung or Acute Pulmonary Toxicity from inhalation (smoking/snorting) of cocaine. Learning points: – acute lung injury from cocaine happens usually with use within 48 hrs […]
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 ) […]
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 […]