Internal Medicine Commons^™

Spitting Blood And Casts With Mud: A Rare And Unusual Presentation Of C3 Glomerulonephritis, Gerardo Mederos, Harsh Patel, Menalee Hapuarachchi, Som Aftabizadeh, Prashanth Reddy, Ranjit Nair, Dana Ciobanu, Machaiah Madhrira

Internal Medicine

C3 glomerulonephritis (C3GN) is a rare disease that falls under the umbrella of C3 glomerulopathy. It is manifested by abnormal activation of the alternate pathway resulting in complement deposition in the glomeruli. Kidney biopsy with characteristic findings of electron-dense deposits in the mesangial and capillary wall confirms the diagnosis. Until recently, C3GN presenting with primarily lung involvement had not been reported. We present a unique case of initial pulmonary manifestation C3GN.

Guillain Barre Syndrome In A Patient With Sickle Cell Anemia, Kunjan Udani Md, Pooja Patel, Dveet Patel, Hajra Awwab, Nino Balanchivadze

Internal Medicine

No abstract provided.

Using Education To Increase Compliance With Heart Failure Medications, Kara Stout Do, Isaac Navarro Dmd

Internal Medicine

• Approximately 5.7 million adults in the United States have heart failure.
• 25% of individuals die within one year of diagnosis and more than 80% die within 8 years.
• Full adherence to medications may be as low as 30% in heart failure patients.
• Non-compliant patients are two times more likely to be readmitted to the hospital and have a three times higher mortality rate.

Moyamoya Disease Presenting With Stroke, Timothy Collins, Chimezie Ubbaonu, Phuong Vo

Internal Medicine

No abstract provided.

Choking On Adenocarcinoma, Andre Sahakian Md, Rajesh Gulati Md

Internal Medicine

No abstract provided.

So Much Soma, Satvir Dhillon Md, Gregory Shimizu Md

Internal Medicine

No abstract provided.

Blue Rubber Bleb Nevus Syndrome, Danielle Kocsis, Anthony Dupuy, Stacey Wice, Aftab Ahmad, Tehmina Yaquibi

Internal Medicine

No abstract provided.

Nitrofurantoin Induced Lung Toxicity: A Rare Adverse Effect, Farrah Chilet Md, Nour Tlimat Md, Salman Muddassir Md

Internal Medicine

No abstract provided.

Nivolumab Induced Myasthenia Gravis, Elizabeth Henderson Md, Imad Ikhawn Md, Dharti R. Patel Md, Monicka Felix

Internal Medicine

No abstract provided.

Cutaneous Leishmaniasis In A Traveler: A Case Report, Sarah Al-Obaydi Md, Nemer Dabage Md, James Demaio Md

Internal Medicine

Leishmaniasis, a vector-borne infection transmitted by sandflies, is endemic throughout the Mediterranean basin and the tropics. We present a case diagnosed in Florida after overseas travel.

Anxiety Induced Pulmonary Edema: A Rare Occurrence, Anum Akhlaq Md, Neda Shahoori, Alexandra Mary Kelada, Aftab Ahmad

Internal Medicine

No abstract provided.

Sensorimotor Polyneuropathy As The Initial Presentation Of Sarcoidosis: A Case Report Of A Rare Manifestation, Melanie Rojas, Lakshpaul Chauhan Md, Arshad M. Iqbal Md, Sadia Tufail, Nikolay Mitzov

Internal Medicine

No abstract provided.

Geriatric Hepatology: The Hepatic Diseases Of The Elderly And Liver Transplant, Shima Ghavimi, Hamed Azimi, Neel Patel, Oleg Shulik

Internal Medicine

Introduction: With the aging US population, chronic liver diseases are becoming more commonly diagnosed in the geriatric population. Advanced age leads to changes in liver blood flow, volume, morphology and normal physiology. This predisposes elderly patients to develop certain chronic liver diseases. Also, the clinical course and management differ in an older patient when compared to a younger patient. Some causes of chronic liver disease in the geriatric population include Hepatitis A, B, C, Non-Alcoholic Fatty liver disease, prolonged alcohol use and inflammation. Many chronic liver diseases are characterized by a slow, indolent course of progression with non-specific symptoms and …

Duodenal Variceal Bleeding With Large Spss Treated With Transjugular Intrahepatic Portosystemic Shunt And Embolization: A Case Report, Rohit Anand, Saad Emhmed Ali, Driss Raissi, Wesam M. Frandah

Internal Medicine

Background: Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part of duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of SPSS was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. Case Summary: A 43-year-old cirrhotic male presented with melena for three days. Upper endoscopy was performed and showed active blood oozing from the distal duodenum concerning for ectopic duodenal varix. …

Pulmonary Alveolar Microlithiasis Diagnosed With Radiography, Ct, And Bone Scintigraphy, Emad Alkankan, Hasan Yamin, Hazim Bukamur, Fadi Alkhankan, Yousef Shweihat, Fuad Zeid

Internal Medicine

Pulmonary alveolar microlithiasis is rare disease characterized by accumulation of calcium phosphate microlithis in the alveoli. The pathogenesis relates to mutation in the gene SLC34A2 (solute carrier family 34 member 2) located on chromosome 4p15.2, which produces a defective sodium-phosphate cotransporter in alveolar epithelial type-2 cells, making these cells unable to clear phosphorus released during recycling of surfactant.

Should A Fully Covered Self-Expandable Biliary Metal Stent Be Anchored With A Double-Pigtail Plastic Stent? A Retrospective Study, Saad Emhmed Ali, Wesam M. Frandah, Leon Su, Cory Fielding, Houssam Mardini

Internal Medicine

Background: The migration rate of fully covered self-expandable metal stents (FCSEMSs) has been reported to be between 14% to 37%. Anchoring of FCSEMSs using a double-pigtail plastic stent (DPS) may decrease migration. Aim: To compare stent migration rates between patients who received FCSEMS alone and those who received both an FCSEMS and anchoring DPS. Methods: We conducted a retrospective analysis of endoscopy reporting system and medical records of 1366 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS placement at the University of Kentucky health care. Between July 2015 and April 2017, 203 patients with FCSEMS insertion for the treatment …

Using The Ebus Scope In The Esophagus, Yousef Shweihat, Shantanu Singh

Internal Medicine

This chapter aims at introducing the interested Pulmonologist/Interventional Pulmonologist to the esophageal ultrasound. In this chapter, we give short descriptions of some technical aspects of the endobronchial ultrasound (EBUS) scope and explain in detail why we believe the EBUS scope is well suited to be an esophageal scope in the hands of the trained pulmonologist. The chapter then explains indications and benefits of this procedure that we consider central to the practice of chest physicians. We also describe in steps how to reach each lymph node station using the EBUS scope as a EUS scope (EUS-B) from our own experience. …

Eus-B For The Interventional Pulmonologist Using The Ebus Scope In The Esophagus, Yousef Shweihat, Shantanu Singh

Internal Medicine

This chapter aims at introducing the interested Pulmonologist/Interventional Pulmonologist to the esophageal ultrasound. In this chapter, we give short descriptions of some technical aspects of the endobronchial ultrasound (EBUS) scope and explain in detail why we believe the EBUS scope is well suited to be an esophageal scope in the hands of the trained pulmonologist. The chapter then explains indications and benefits of this procedure that we consider central to the practice of chest physicians. We also describe in steps how to reach each lymph node station using the EBUS scope as a EUS scope (EUS-B) from our own experience. …

Prognosis Of Patients With Aki After Percutaneous Mechanical Thrombectomy: A Retrospective Cohort Analysis, Hongchuan H. Coville Md, Tien-Min Lee Md, Hong Liang, Paul Alfino Md, Christopher Bray Md, Matthew Calestino Md

Internal Medicine

Percutaneous Mechanical Thrombectomy (PMT) is an endovascular procedure utilized in both arterial and venous thrombosis. Acute kidney injury (AKI) has been recognized as one undesired sequela of PMT. There is no study to investigate the outcomes in this specific patient population.

A Case Of Flecainide Toxicity In A Young Male, Ifrah Butt, Umair Shaikh, Marlena Fernandez, Sameer Shaharyar, Daniel Heller

Internal Medicine

No abstract provided.

Massive Hemoptysis Due To Recurrence Of Bronchial To Pulmonary Vascular Malformation: A Case Report, Chelsey White, Pedro Ottaviano, Nancy Munn, Yousef Shweihat, Fuad Zeid

Internal Medicine

Bronchial dieulafoy lesions are quite rare with relatively few case reports in the literature. Symptoms may vary but the lesion is often associated with hemoptysis and may present as massive hemoptysis. We present a case of a 69-year-old male with a recurrent episode of hemoptysis three years after treatment for a bronchial dieulafoy lesion. The bronchoscopy done three years prior during an initial episode of hemoptysis showed a visible dieulafoy deep within a subsegmental branch of the right lower lobe. This case is unique because there are no other reports within the literature of a delayed recurrence several years after …

Case Report: Steroid Responsive Mesothelioma-Related Pleural Effusion, Mena Shehata, Fouad Zaid, Peter Ottaviano, Yousef Shweihat, Nancy Munn

Internal Medicine

Malignant pleural mesothelioma (MPM) is an asbestos-related tumor arising in the pleural cavity. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. The most common radiologic presentation is ipsilateral pleural effusion with or without pleural thickening or a mass. Thoracoscopic biopsy remains the most appropriate procedure for definitive diagnosis of mesothelioma. Despite advancement in diagnostic procedures and biomolecular research, this tumor nevertheless has poor prognosis. Mesothelioma remains a diagnostic and therapeutic challenge and is likely to remain one in …

Clostridium Sporogenes Bacteremia In An Immunocompetent Patient, Waiel Abusnina, Mena Shehata, Emhemmid S. Karem, Zeynep C. Koc, Elie Khalil

Internal Medicine

Of the 200 Clostridium spp. known to exist, approximately 30 have been associated with human disease. Commonly found in soil, marine sediment and mammalian intestinal tracts, these gram-positive bacilli are known to cause infections ranging from cellulitis to septicemia. Isolates that are identified by clinical microbiology laboratories include Clostridium perfrigens species in 20–40% of cases. However, when Clostridium sporogenes is identified, is rarely considered to be pathogenic. We present a case of Clostridium sporogenes bacteremia secondary to lower limb cellulitis and osteomyelitis in an immunocompetent patient.

A Rare Case Of Metastases From A High-Grade Astrocytoma To The Pleura, Bones, And Liver Within Six Months Of Diagnosis, Jennifer L. Dotson, Ala Nijim, Krista L. Denning, Yousef R. Shweihat, Yehuda Lebowicz

Internal Medicine

High grade astrocytomas such as anaplastic astrocytoma and glioblastoma multiforme are aggressive central nervous system malignancies with a poor prognosis. Due to shortened survival times, their devastating effects are usually localized intracranially and rarely metastasize outside of the central nervous system. When metastases occur, they usually present in patients with longer survival times and they typically coincide with a primary site recurrence. We present a rare case of metastases from a high-grade astrocytoma/glioblastoma to the pleura, bones and liver within six months of diagnosis, without primary site recurrence.

Ammonia Vs. Lactic Acid In Predicting Positivity Of Microbial Culture In Sepsis: The Alps Pilot Study, Yazan Numan, Yasir Jawaid, Hisham Hirzallah, Damir Kusmic, Mohammed Megri, Obadah Aqtash, Ahmed Amro, Haitem Mezughi, Emmon Maher, Yonas Raru, Jamil Numan, Sutoidem Akpanudo, Zeid Khitan, Yousef Shweihat

Internal Medicine

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients.

Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days.

Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 …

Exploring The Excluded Stomach: A Case Series Of Novel Endoscopic Techniques To Diagnose Gastric Cancer In The Excluded Stomach After Roux-En-Y Gastric Bypass Surgery, Saeed Ali, Abdelkader Chaar, Wesam Frandah, Rola Altoos, Zeeshan Sattar, Muhammad Hasan

Internal Medicine

Gastric cancer is the fifth most common malignancy worldwide and the fourth leading cause of cancer-related deaths. The diagnosis is usually made by direct visualization with supporting histopathology. However, patients with gastric bypass surgery pose a challenge in diagnosis due to the difficulty in the evaluation of the excluded stomach. We present two cases of gastric cancer in the excluded stomach after Roux-en-Y gastric bypass (RYGB) surgery was diagnosed using two different endoscopic approaches.

Urinothorax Caused By Xanthogranulomatous Pyelonephritis, Waiel Abusnina, Hazim Bukamur, Zeynep C. Koc

Internal Medicine

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.

Gastric Calcifying Fibrous Tumor Mimicking Gi Stromal Tumor, Nneoma Okoronkwo, Shima Ghavimi, Ravi Chokshi, Stephen Peters, Sushil Ahlawat

Internal Medicine

A 27-year-old female with no significant medical history was referred for an EUS to evaluate a large, firm, gastric mass, which was detected during esophagastroduodenoscopy done for persistent reflux symptoms and intermittent epigastric pain. EUS revealed a polypoid, broad-based, solid intramural mass, 2 cm x 4 cm in size, heterogeneous in echo-texture with calcifications and post-acoustic shadowing. The polypoid gastric mass appeared to arise from the muscularis propria.

The Role And Safety Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Diagnosis And Management Of Infected Bronchogenic Mediastinal Cysts In Adults, Hazim S. Bukamur, Emad Alkhankan, Haitem Mezughi, Nancy J. Munn, Yousef R. Shweihat

Internal Medicine

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such …

Small Cell Carcinoma Of Prostate: A Case Report Of A Patient With Concomitant Transitional Cell Cancer Of The Bladder, Waiel Abusnina, Eric Y. Auyoung, Mohammed Megri, Toni H. Pacioles

Internal Medicine

Small cell carcinomas (SCCs) are aggressive neoplasms commonly associated with a pulmonary origin. However, albeit rare, extrapulmonary SCC can occur in a variety of sites with an incidence in North America approximated to be 0.1% to 0.4%. Among these sites, approximately 10% of extrapulmonary SCC cases occur in the prostate and are associated with a poor mortality with a median survival of 10 months. Because of the rarity of the prostatic SCC, there is no formal treatment protocol. In this case report, we present a patient who was diagnosed with SCC in the prostate as primary origin. Adjuvant concurrent chemoradiotherapy …