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Acute Hiv, Rhabdomyolysis, Renal Failure, And Hepatitis: A Case Report, Eve R. Merrill, Md

The Medicine Forum

Case Report

A 19 year old African-American male with no significant past medical history presented to an outside hospital with two days of diffuse abdominal pain, myalgias, muscle weakness, and darkurine. Two weeks prior to presentation, the patient was treated as an outpatient with an unknown antibiotic for symptoms of a sore throat, nausea, and non-bloody, non-bilious emesis. The patient denied any sick contacts, recent travel, trauma, strenuousexercise, or the use of non-steroidal anti-inflammatory drugs, acetaminophen, alcohol, or illicit drugs. The patient reported being sexually active with one female partner and had no historyof sexually transmitted infections. The patient was …

Download Entire Issue-The Medicine Forum, Volume 11, 2009

The Medicine Forum

Download entire issue-The Medicine Forum, Volume 11, 2009

A 30 Year-Old Man Infectious Endocarditis And Cerebrovascular Accident, Neerav G. Sheth, Md, Joseph Desimone, Md

The Medicine Forum

Case Report

A 30 year old male with a remote history of intravenous drugabuse (IVDA) and Hepatitis C was admitted in July 2008 with changes in mental status and a new right sided paresis. According to the family, the patient was in his usual state of health until approximately 2-3 weeks prior to admission when he developed headaches, generalized malaise, and fever to 101 degrees Fahrenheit after swimming in a lake. He was seen in an outside hospital emergency department, diagnosed with otitis media and subsequently discharged on prednisoneand ciprofloxacin. The morning of admission, the patient was found naked, nonverbal, …

The “Great Imitator” Presents With Abnormal Liver Enzymes, Ikumi Suzuki, Ms Iv, Nicholas Orfanidis, Md, Stephanie Moleski, Md, Leo C. Katz, Md, David Kastenberg, Md

The Medicine Forum

Case Report

A 28 year-old male was referred to the gastroenterology clinic for evaluation of abnormal liver enzymes. Three months prior to presentation he was evaluated at a local emergency department for vomiting and upper abdominal pain. He described pain as epigastric and worse after eating. He denied fever, chills orchanges in his urine. At that time, the patient was not jaundiced but reported having a rash. Laboratory testing was remarkablefor elevated liver enzymes (Table 1). The patient was advised to follow up with his primary care physician. Though his symptoms resolved without medical therapy, liver enzymes obtained a few …

Histiocytic Sarcoma: A Case Of A 52-Year-Old Female With Two Synchronous Primary Malignancies At Presentation, Ryan D. Gentzler, Md, Daron A. Kahn, Md

The Medicine Forum

Case Report

A 52-year-old female with a past medical history of chronicobstructive pulmonary disease, coronary artery disease, andan 80-pack-year smoking history presented to the emergency room with complaints of right upper extremity weakness and imbalance while walking for the previous two days. She stated that the onset was abrupt and progressively worsening to the point where she could no longer lift her right upper extremityagainst gravity. She maintained the ability to move her hand and grasp, but admitted to decreased strength and decreased dexterity of her right hand. She denied changes in vision. She also denied having bowel or bladder …

A Case Of Babesiosis Complicated By Hepatic And Renal Failure, Steven Krawitz Ms Iv, Nilay Kavathia Md, Pratik Choksy Mbbs

The Medicine Forum

Case Report

A 67-year-old male with a past medical history of chronic kidneyinsufficiency, splenectomy, and recurrent babesiosis infectionwas transferred to with jaundice and abdominal pain.The patient initially presented to an outside hospital (OSH) withgeneralized weakness, chills, and gastrointestinal symptoms andwas found to have Babesia on peripheral blood smears. The patient received seven days of azithromycin and atovaquone,followed by three days of clindamycin and quinine sulfate.The patient was discharged home with improved symptomsand a negative peripheral blood smear. Less than 24 hourslater he returned to the OSH with worsening myalgias andabdominal pain. Physical exam was significant for jaundiceand hepatomegaly. Laboratory data …

A Case Of An Atypical, Community Acquired Pneumonia: A Case Summary And Topic Review, David P. Cork Ms Iv, Joanne Kim Md, Jie Cui, Md

The Medicine Forum

Case Report

A 59 year old gentleman with a past medical history ofhypertension, hyperlipidemia, anxiety, depression, arthritis,and hypothyroidism presented with a five day history of feverto 102º F. He complained of a three-day history of nausea,vomiting, and non-bloody, loose diarrhea, all of which hadbeen persistent and worsening over the past week. Over thepast two days, the patient had felt short of breath, and presentedin a state of severe dyspnea. He had experienced an indolentcourse of illness, but was now concerned with his tachynpea andwheezing, and he had developed a productive cough with a smallamount of yellow-brown sputum. He denied any …

Table Of Contents, The Medicine Forum, Volume 11, 2009

The Medicine Forum

Table of Contents, The Medicine Forum, Volume 11, 2009

Download Entire Issue-The Medicine Forum, Volume 10, 2008

The Medicine Forum

Download entire issue-The Medicine Forum, Volume 10, 2008.

Man With Swollen Eye, Blurred Vision, And Fevers In The Setting Of Newly Diagnosed Mds, Rory Bowers, Md

The Medicine Forum

Case Presentation

An 82 year-old male with a past medical history of prostatecancer, atrial fibrillation, gout, and recently diagnosed myelodysplasticsyndrome presented with a chief complaint of left eyepain. The patient also reported peri-orbital numbness, swelling,and clear discharge as well as episodic blurry vision of his lefteye. Over the previous two months he had been admitted to thehospital multiple times complaining of cough and high feversand was subsequently treated with several courses of antibioticsfor presumed pneumonia. During the initial admission forpneumonia he was noted to have a relative pancytopenia. Abone marrow biopsy was eventually undertaken revealing adiagnosis of myelodysplastic syndrome (MDS).

A Case Of Severe Anemia In An Aids Patient, Amy K. Slenker, Md, Rahul Anand, Md

The Medicine Forum

Case Presentation

A 49 year-old African-American male presented to ThomasJefferson University Hospital in April of 2008 complaining ofgeneralized weakness and lightheadedness for 4 months. Thepatient had a medical history of HIV/AIDS diagnosed in 2002with a CD4 count of 0 cells/mm3 in 2005 and a history of noncompliancewith highly active retroviral therapy (HAART). InDecember of 2007 the patient was diagnosed with cryptococcalmeningitis and had a concomitant anemia with a hemoglobinof 5.3 g/dL. At that time laboratory studies for parvovirus B19(PB19) showed an IgG of 0.79 units and an IgM of 0.63 units( a value less than 0.89 is considered negative). PB19 …

A 57 Year-Old Man With Prolonged Shortness Of Breath And Fevers, Loren Chen, Md

The Medicine Forum

Case Presentation

A 57 year-old Caucasian male was initially admitted to MethodistHospital from an outside hospital for dehydration, increasedheart rate, and weight loss. He has a past medical history ofcoronary artery disease status post myocardial infarction andcoronary artery bypass graft, congestive heart failure, paroxysmalatrial fibrillation on coumadin, diabetes type II on insulin, andan orthotopic liver transplant in 1997 for end-stage liver diseasesecondary to hepatitis C virus and alpha-1 antitrypsin disorder.

A Man With Invasive Community Acquired-Mrsa Infection In The Icu Setting, Jason Korenblit, Md, Mba

The Medicine Forum

Case Presentation

A 66 year-old male presented to the emergency department (ED)with complaints of two days of shortness of breath and pruritis.The patient claimed that he had not had regular medical care formore than 15 years and admitted to no past medical history orchronic medications. One week prior, he reported an itchy rashon both his forearms. He sought treatment at a local free clinicand received a low-potency steroid cream which he used withoutrelief. While at a family event, he became increasingly dyspneicand was brought to the ED by his family. He reported no surgicalhistory and no drug allergies or food …

Case Reports A 31 Year-Old Man With Chest Pain, Rash, And Ekg Changes, Neerav Sheth, Md,, Rahul Anand, Md, Matthew Stopper, Md

The Medicine Forum

Case Presentation

A 31 year-old Caucasian male with no significant past medicalhistory presents with increasing dizziness, chest pain, andshortness of breath of one day duration. On returning from acamping trip to Northern Pennsylvania three weeks prior toadmission, he noted high fevers, “joint pains all over,” and a pinkblotchy rash all over his chest and back. He did not recall anyinsect, tick or animal bites. His primary physician, who clinicallysuspected Lyme disease, ordered Lyme serologies and offered aprescription for doxycycline which the patient declined. Twoweeks later, the patient presented to the emergency departmentafter the onset of chest pain that he described …

Tjuh Adherence To Idsa Guidelines For The Treatment Of Cryptococcal Meningitis, Matthew Grant, Md

The Medicine Forum

Introduction

Cryptococcal meningitis is an infectious complication of immunecompromised states that carries a high rate of mortality orrelapse. Although Infectious Disease Society of America (IDSA)guidelines outline the recommended treatment regimen forcryptococcal meningitis, clinicians take a heterogenous clinicalapproach. This study examines the use of antifungal regimens intreating cryptococcal meningitis at a tertiary care hospital.

Man With Malaria In Delaware, Benjamin Ngo, Md

The Medicine Forum

Case Presentation

A 37-year-old African American male presented to the hospital complaining of high fevers over the past two weeks associated with severe posterior headache. He described having had a very poor appetite recently, but denied any cough, abdominal pain, diarrhea, or urinary symptoms. He did not recall sustaining any head trauma. He did relate, however, that he had recently returned from a three-month trip to Kenya ~1 month prior to this presentation. He had no past medical history and was not on any medications. He did not use IV drugs. Physical exam confirmed a fever of 102.1o F though …

Woman With Aids And Status Epilepticus, Bonnie Callahan, Md

The Medicine Forum

A 42 year-old female with a medical history of HIV presented to the Emergency Department with nausea and vomiting for the past five days. Six days prior to presentation, she had one week of symptoms of progressive dyspnea and non-productive cough which were evaluated by her primary care physician. At that time, blood work revealed a CD 4 count of 150 cells/mm3 and a chest x-ray was suggestive of pneumonia. She was given a prescription of trimethoprim-sulfamethoxazole (TMP/SMX) and guaifenesin with codeine. Within twenty-four hours of starting the prescribed medications, she developed nausea and vomiting, and she stopped taking both …

Fool, Marshall Fleurant, Md

The Medicine Forum

They say God protects fools and the innocent

They say God protects the innocent and the souls of children

Unfortunately the years of childhood has passed me

I doubt that God looks upon me as innocent

So I pray to be the fool

Woman With Relapsing Fevers, Mary Kate Mccullen, Md

The Medicine Forum

A 50 year-old Nigerian woman with a past medical history significant for type II diabetes and hypertension presented to the ED with a chief complaint of recurrent fevers and chills. The patient was in her usual state of health until approximately 6 weeks prior to admission, while during a visit with family in Nigeria she noted the onset of high fevers and general malaise. Initially, her fevers occurred daily for a period of one week, and were associated with chills, fatigue, loss of appetite, and myalgias. During this time, she was not evaluated by a physician, nor did she take …

Herpes Zoster Ophthalmicus With Third Nerve Palsy, Bonnie Callahan, Md, Utpal Sagar, Md, Ted Martynowicz, Do

The Medicine Forum

Introduction

Herpes zoster is a recurrent infection of the varicella-zoster virus. When it infects the periorbital region, the virus often involves the ocular structures, and may lead to more disastrous sequelae, including blindness. Despite advancements, including immunization and antiviral therapy, zoster ophthalmicus persists in the population. Therapy mitigates, but does not obviate, many of the complications of infection. Our paper describes a patient with herpes zoster ophthalmicus that presented from the community.

Recruitment And Retention Of Diverse Populations In Antiretroviral Clinical Trials: Practical Applications From The Gender, Race And Clinical Experience Study., Ron Falcon, Dawn Averitt Bridge, Judith Currier, Kathleen Squires, Debbie Hagins, Deborah Schaible, Robert Ryan, Joseph Mrus

Division of Infectious Diseases and Environmental Medicine Faculty Papers

BACKGROUND: Women, particularly women of color, remain underrepresented in antiretroviral (ARV) clinical trials. To evaluate sex-based differences in darunavir/ritonavir-based therapy, the Gender, Race And Clinical Experience (GRACE) study was designed to enroll and retain a high proportion of women representative of the racial/ethnic demographics of women with HIV/AIDS in the United States. The recruitment and retention strategies used in GRACE are described in this article.

METHODS: Recruitment and retention strategies targeting women included selecting study sites that focused on women, involving community consultants, site-specific enrollment plans, access to other ARV drugs, study branding, site and patient toolkits, targeted public relations, …

Download Entire Pdf: The Medicine Forum, Vol 7, 2005

The Medicine Forum

Download the entire PDF of The Medicine Forum, Volume 7, 2005.

41 Year Old Women With Fevers And Shortness Of Breath, Jonathan Jun, Md

The Medicine Forum

A 41 year-old African American female with a history of asthma, hypertension, and schizophrenia presented to the ER in February 2005 with shortness of breath, wheezing, and a “wet-sounding” but nonproductive cough. She reported chills, subjective fever, rhinorrhea, and malaise for five days prior. Her only medication was albuterol, which she normally used twice weekly as needed. She was never intubated for asthma. On review of systems, she had progressive dyspnea on exertion of less than two blocks for the last year. She denied night sweats, weight loss, or sick contacts, HIV exposure, alcohol or drug abuse. She admitted to …

An 18-Year Old Man With Fever And Headache, Amy Baranoski, Md

The Medicine Forum

An 18-year-old man was transferred from an outside hospital for evaluation of recent headache, fevers, and laboratory abnormalities.

The patient had a past medical history significant for attention deficit hyperactivity disorder (ADHD) and had presented to an outside hospital with complaints of fatigue, fever, and headache. He described the headache as frontal, severe, and stabbing in nature without associated neck stiffness, photophobia, or phonophobia. He also reported fevers to 105ºF. He was evaluated one day after the onset of symptoms at a local emergency room where a lumbar puncture was performed. By report of the patient and his mother, the …

Download Entire Issue-The Jefferson Medicine Forum, Volume 6, Winter 2004

The Medicine Forum

Download entire issue-The Jefferson Medicine Forum, Volume 6, Winter 2004.

Images In Medicine-Clostridial Myonecrosis, Jaime Chin Md, Pgy-3

The Medicine Forum

A 48 year-old male with a past medical history of gout,

degenerative disc disease, and T cell lymphoma treated

with chemotherapy and autologous peripheral blood

stem cell transplant, currently in remission, presented

seven days status-post a non-myeloablative allogeneic

transplant with an acute onset of excruciating left hip

and groin pain and a low-grade fever. The physical exam

did not reveal any obvious cause of his extreme pain.

What's Your Diagnosis? Lung Cavitary Lesion, Bassem Elgohary Md, Pgy-3, Betty Lim Md, Pgy-2

The Medicine Forum

A 35 year-old Caucasian woman with history of Systemic
Lupus Erythematous (SLE) complicated by Lupus
glomerulonephritis presented to the Emergency
Department complaining of worsening bilateral lower
extremity rash and leg pain. The rash had been present
for over a month and a recent biopsy of the lesion
revealed leukocytoclastic vasculitis. Her usual dose of
prednisone 120mg every other day had been increased
to 60mg daily over the past few weeks with the worsening
rash. In addition to the rash and leg pain, she also
reported some right-sided pleuritic chest pain.
Otherwise, the patient noted no shortness of breath,
cough, fevers, …

Research On Healthcare Worker Personal Protective Equipment: Minimum Requirements For Isolation Gowns, F.Selcen Kilinc-Balci, Phd

Building the Chain of Safety: Stakeholders Summit

F. Selcen Kilinc-Balci, PhD, is a Senior Service Fellow at the National Personal Protective Technology Laboratory (NPPTL) of Centers for Disease Control and Prevention (CDC)/National Institute for Occupational Safety and Health (NIOSH). She works in the area of protective clothing and ensembles, including personal protective equipment for healthcare workers, mine rescue ensembles, fire fighter turnout gear, and chemical protective garments. Prior to joining NIOSH in February 2010, she worked as a senior engineer at DuPont Protection Technologies. Her work at DuPont focused on product development, product testing and certification, and promotional claim validation in personal protective clothing. She has more …

Adoption Of Protective Uniforms, Thomas J. Walsh, Md, Facp, Fccp, Faam, Fidsa

Building the Chain of Safety: Stakeholders Summit

Thomas J. Walsh, MD, FACP, FCCP, FAAM, FISDA, is Professor of Medicine (appointment pending) and Director of the new Transplantation-Oncology Infectious Diseases Program at Weill Medical College of Cornell University. Following graduation from Johns Hopkins University School of Medicine, Dr. Walsh completed ten post-doctoral years of laboratory investigation, clinical research and patient care leading to boards in Medicine, Infectious Diseases and Oncology and laboratory expertise in pharmacology, innate host defenses, and medical mycology.

Following a distinguished career in the Pediatric Oncology Branch of the National Cancer Institute, Dr. Walsh was recruited to direct the new Transplantation-Oncology Infectious Diseases Program of …

Exposure Risks And The Chain Of Healthcare-Associated Infection, Amber Hogan Mitchell, Drph, Mph, Cph

Building the Chain of Safety: Stakeholders Summit

Amber Hogan Mitchell, DrPH(c), MPH, CPH is the Worldwide Director of Professional Education and Learning Solutions for Advanced Sterilization Products (ASP), a Johnson & Johnson Company located in Irvine, CA.  Amber is responsible for educational initiatives for ASP and its customers related to infection prevention, healthcare associated infections, sterilization, disinfection, environmental hygiene, and quality initiatives in healthcare related to safe care and quality patient outcomes.  Amber is a Doctor of Public Health Candidate (all but dissertation) in occupational and environmental health sciences at the University of Texas School of Public Health in Houston, TX.  She was a Centers for Disease …