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Stay, Jennifer Alloo Hong, Md
Stay, Jennifer Alloo Hong, Md
The Medicine Forum
As an intern, I thought of myself as the member of the team who gets the things done. I took pride in prioritizing my long list of tasks and efficiently working through each item. I spent most of my time at the computer, on the phone, in front of the chart, or in a consultant’s office. My time with patients was so limited that I grew more comfortable thinking about their medical problems away from their bedside.
Swyer-James-Mcleod Syndrome, Esther Molnar, Md, Arun Matthew, Md
Swyer-James-Mcleod Syndrome, Esther Molnar, Md, Arun Matthew, Md
The Medicine Forum
Admission chest x-ray of an 81 year-old man admitted to the hospital for atrial fibrillation with rapid ventricular response is shown in Figure 1. The chest x-ray shows a unilateral hyperlucent lung, with paucity of peripheral vessels and decreased lung volume. Differential diagnosis for unilateral hyperlucent lung includes Swyer-James-McLeod syndrome (SJMS), centrilobular emphysema, allergic bronchopulmonary aspergillosis, congenital lobar over inflation, bronchial atresia and congenital interruption of pulmonary artery.1 High resolution CT imaging confirmed the diagnosis of SJMS in this patient.
Pyoderma Gangrenosum Associated With Acute Myelogenous Leukemia, Lekha Mikkilineni, Md, Aishah Ali, Md
Pyoderma Gangrenosum Associated With Acute Myelogenous Leukemia, Lekha Mikkilineni, Md, Aishah Ali, Md
The Medicine Forum
A 20-year-old man presented with a non-healing ulcer on the dorsum of the left foot that initially appeared after the patient fell and hit his left foot on the edge of a door. An ulcer had formed and grown in size over the past several weeks after repeated physical insults and despite home wound care, as seen in Figure 1. Additionally, the patient had a non-healing ulcer inferior to his left knee. He had a notable past medical history of acute myelogenous leukemia (AML) in remission after a haploidentical stem cell transplant, uncontrolled diabetes type 1, and graft-versus-host disease of …
Tb, Or Not Tb?, Michael A. Valentino, Md, Phd
Tb, Or Not Tb?, Michael A. Valentino, Md, Phd
The Medicine Forum
The patient is a 43-year-old African American male with a past medical history of hypertension, hyperlipidemia, and chronic low back pain who presented to the ER for worsening dyspnea and a 30-lb weight loss over the past 3 months. He also reported a nonproductive cough over this period of time as well as an eruption of small ~1cm flesh-colored nodules on his extremities and trunk. He denied any fevers, chills, or night sweats. In the ER, he had a chest x-ray performed (Figure 1) which showed diffuse centrilobular nodules visualized throughout the lung fields in a miliary pattern. He subsequently …
Technique For Safe Placement Of A Dobhoff Tube Without A Cortrak® Machine, Jon Chao, Md, Jennifer Alloo Hong, Md
Technique For Safe Placement Of A Dobhoff Tube Without A Cortrak® Machine, Jon Chao, Md, Jennifer Alloo Hong, Md
The Medicine Forum
A 58 year old female with a history of end stage renal disease on hemodialysis, insulin dependent diabetes mellitus, ischemic cardiomyopathy, and adrenal insufficiency, presented from home with altered mental status and hypotension. She developed refractory hypotension requiring vasopressors and was admitted to the medical ICU for management of septic shock due to bacterial peritonitis. She was intubated and had an oro-gastric tube placed for enteral nutrition. However, significantly elevated gastric residuals developed secondary to delayed gastric emptying. We decided to place a post-pyloric Dobhoff tube as an alternative gastric access to continue enteral feeding. Since a Cortrak machine (an …
A Case Of Body Packing: Internal Smuggling Of Illicit Drugs, Michael A. Valentino, Md, Phd
A Case Of Body Packing: Internal Smuggling Of Illicit Drugs, Michael A. Valentino, Md, Phd
The Medicine Forum
The patient is a 27-year old Hispanic female who was brought to the ER from the airport by the Drug Enforcement Agency (DEA) on suspicion of “body packing” (illicit drug smuggling via ingestion). An abdominal X-ray (Figures 1a,b) was obtained in the ER which showed multiple radiopaque foreign bodies which were uniform in size measuring 5 cm x 2 cm throughout her colon. The patient then admitted to ingesting numerous heroin pellets. She subsequently had a CT Abdomen/Pelvis performed (Figure 2) which again showed numerous tubular radiopaque foreign bodies throughout the gastrointestinal tract. She was admitted to the medical intensive …
A Case Of Fanconi’S Syndrome In A Patient With Hiv, Mariam Kabir, Md, Phd, Christopher Miller, Md, Rakesh Gulati, Md, Mrcp, William R. Short, Md, Mph
A Case Of Fanconi’S Syndrome In A Patient With Hiv, Mariam Kabir, Md, Phd, Christopher Miller, Md, Rakesh Gulati, Md, Mrcp, William R. Short, Md, Mph
The Medicine Forum
Introduction
Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue reverse transcriptase inhibitor (NtRTI), which blocks reverse transcriptase, an enzyme found in HIV. Since its approval for use in HIV by the FDA in 2001, it has contributed to effective treatment in numerous patients. The most common side effects include nausea, vomiting, diarrhea, asthenia, abdominal pain and hepatotoxicity. A less common side effect is nephrotoxicity leading to Fanconi’s syndrome. Here is an interesting case of Fanconi’s Syndrome caused by Tenofovir.
Case
A 50-year-old Caucasian female with a past medical history of HIV and Hepatitis C presented to the Emergency Department with …
A Case Of Septic Portal Vein Thrombosis (Pylephlebitis), Erin Carnish, Md, Andrew Garrett, Md, Mary Slome, Ms1
A Case Of Septic Portal Vein Thrombosis (Pylephlebitis), Erin Carnish, Md, Andrew Garrett, Md, Mary Slome, Ms1
The Medicine Forum
INTRODUCTION
Pylephlebitis, defined as suppurative thrombosis of the portal vein often associated with bacteremia, is a rare and serious complication of intra-abdominal infections. Prior to antibiotics, the mortality rate of this disease approached 100%.1 The veins adjacent to the infection are the first to be involved, with later spread to the portal vein and possibly the mesenteric and splenic veins.2-3 Extension into the mesenteric veins can lead to bowel necrosis and increased morbidity and mortality.2-4
CASE PRESENTATION
A 63-year old male with a history of hypertension presented to the emergency department with one week of progressively worsening malaise, chills, severe …
Hepatitis C Therapy: Serendipitous Successes, Apeksha Shah, Md, Jonathan Fenkel, Md
Hepatitis C Therapy: Serendipitous Successes, Apeksha Shah, Md, Jonathan Fenkel, Md
The Medicine Forum
Introduction
Hepatitis C virus (HCV) infection is a growing epidemic worldwide, with about 170 million cases reported by 2011.1 New therapies have been introduced to the market, but the prior mainstay of therapy involves pegylated interferon-alpha (IFN) along with ribavirin (RBV).2 Treatment with the first generation direct-acting antiviral agent-containing regimens consisted of at least 24 weeks of therapy, with the goal of sustained viral response (SVR) – no detectable virus 24 weeks after treatment is completed. We report two cases in which therapy was terminated early due to the developed of severe infection, yet the patients still achieved SVR.
Case …
A Case Of Complete Heart Block Secondary To Anca-Associated Vasculitis, Krista Lim-Hing, Md
A Case Of Complete Heart Block Secondary To Anca-Associated Vasculitis, Krista Lim-Hing, Md
The Medicine Forum
INTRODUCTION
Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides are systemic autoimmune diseases that often present as non-specific prodromal symptoms such as fever, fatigue, headache, and weight loss.1 With modern treatment, the disease has changed from being universally fatal to being treatable. It can have a chronic relapsing and remitting course. Therefore, early diagnosis is necessary.2,3
CASE PRESENTATION
A 53-year-old male with a past medical history of chronic sinusitis and some epistaxis needing multiple courses of antibiotics and steroids, was admitted after being diagnosed with high-grade heart block at another institution. He was found to have a heart rate of 26 and …
An Unusual Atrial Mass: A Case Study, David F. Reilly, Bs, Christina Lindenmeyer, Md
An Unusual Atrial Mass: A Case Study, David F. Reilly, Bs, Christina Lindenmeyer, Md
The Medicine Forum
BACKGROUND
This case highlights the evolution of a broad differential diagnosis when presented with a rare and diagnostically enigmatic clinical finding.
Recurrent Unilateral Pleural Effusion From Constrictive Pericarditis Of Unknown Etiology Requiring Pericardiectomy, Aishah Ali, Md, Gina Keiffer, Md
Recurrent Unilateral Pleural Effusion From Constrictive Pericarditis Of Unknown Etiology Requiring Pericardiectomy, Aishah Ali, Md, Gina Keiffer, Md
The Medicine Forum
Introduction
Constrictive pericarditis is an uncommon cause of unilateral pleural effusion. In patient’s who have repeated thoracenteses with no obvious cause for the pleural effusion, constrictive pericarditis should be considered. Right and left heart catheterization is used to diagnosis constrictive pericarditis by measuring filling pressures of the heart.
Case Report
A 52-year-old man with a history of hepatitis C, hepatocellular carcinoma (HCC), status post liver transplant in July 2013, chronic kidney disease, gastroesophageal reflux disease and hypothyroidism presented with increasing dyspnea with minimal exertion and was found to have recurrent pleural effusion. Patient had been worked up as an outpatient …
A Rare Case Of Tumor Lysis Syndrome, Anne Mainardi, Ms4, Daniel Okamoto, Md, Jianqing Lin, Md
A Rare Case Of Tumor Lysis Syndrome, Anne Mainardi, Ms4, Daniel Okamoto, Md, Jianqing Lin, Md
The Medicine Forum
INTRODUCTION
Tumor lysis syndrome (TLS) is a metabolic disturbance caused by the destruction of rapidly dividing cancer cells following administration of cytotoxic chemotherapy. The subsequent release of intracellular material results in hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.1 The clinical presentation of TLS, including acute kidney injury, results from these electrolyte abnormalities and can be life-threatening.2 Here we present the second reported case of TLS in a woman with endometrial cancer.
CASE PRESENTATION
A 63 year old woman with newly-diagnosed endometrial cancer (International Federation of Gynecology and Obstetrics, FIGO, stage IVB) who received her first dose of carboplatin and paclitaxel four days …
Anomalous Left Main Coronary Artery Originating From The Right Sinus Of Valsalva, Silpa Yalamanchili, Ms4, Kevin M. Curl, Md
Anomalous Left Main Coronary Artery Originating From The Right Sinus Of Valsalva, Silpa Yalamanchili, Ms4, Kevin M. Curl, Md
The Medicine Forum
Introduction
An anomalous left main coronary artery is a rarely seen clinical entity, particularly when it arises from the right sinus of Valsalva. This case report highlights this uncommon finding and how it affects the care of a patient with significant coronary artery disease.
Case Presentation
A 66 year-old male with a history of hypertension, hyperlipidemia, and type II diabetes presented with progressive exertional mid-epigastric and mid-chest discomfort. The patient stated that he had been feeling this “heaviness” with various activities and occasionally at rest for the past nine months. When it occurred with activity, the pain was generally relieved …
Interventricular Septum Rupture In The Catheterization Laboratory, Xing Zhang, Md, Loheetha Ragupathi, Md
Interventricular Septum Rupture In The Catheterization Laboratory, Xing Zhang, Md, Loheetha Ragupathi, Md
The Medicine Forum
Introduction
This is a case of acute ventricular septal defect (VSD) that was diagnosed while a patient with an acute ST-elevation myocardial infarction (STEMI) was being treated in the cardiac catheterization laboratory. Post-MI VSD is a well-recognized complication of STEMI, and this case was particularly interesting given the circumstances of its diagnosis.
Case Presentation
A 75 year-old female with a history of well-controlled hypertension presented with 3 days of substernal chest pain radiating down her left arm. The pain was severe, unremitting, associated with shortness of breath, nausea, vomiting, and was not relieved by simethicone or by changes in position. …
Fever In A Man With Hiv: An Unusual Case Of An Immune System Gone Wrong, Emily Sutton, Md, Aishah Ali, Md
Fever In A Man With Hiv: An Unusual Case Of An Immune System Gone Wrong, Emily Sutton, Md, Aishah Ali, Md
The Medicine Forum
Introduction
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of immune dysregulation that is often recognized as secondary to an underlying immune activating state, such as malignancy, rheumatologic disorders, and infections. This case highlights an association between HLH and human immunodeficiency virus (HIV) infection. Although HLH is a rare complication of HIV, it presents a difficult challenge for treatment. Without treatment, HLH is invariably fatal, but the consequence of the immunosuppressive treatment regimen in the setting of an underlying opportunistic infection can also have fatal outcomes.
Case Presentation
A 38 year-old man with a history of HIV infection with a CD4 …
Hiv Screening: A Review Of Nationally Recommended Guidelines And Specific Instances In Which Hiv Screening Is Often Overlooked, Anusha Ganesh, Md
Hiv Screening: A Review Of Nationally Recommended Guidelines And Specific Instances In Which Hiv Screening Is Often Overlooked, Anusha Ganesh, Md
The Medicine Forum
INTRODUCTION
According to the Centers for Disease Control and Prevention (CDC), one in five human immunodeficiency virus (HIV)-infected individuals are currently living without knowledge of their diagnosis.1 In 2006, the cost of a rapid HIV test with pre/post-test HIV counseling was anywhere between 48-64 US dollars (USD). The majority of the cost incurred was for HIV counseling, with the cost of the rapid HIV test being between 8-25 USD.2 Research looking at the cost-effectiveness of HIV screening shows that it is more cost-effective than routine screening for breast cancer with mammography yearly or even routine screening for diabetes mellitus with …
A Case Of Fibrosing Mediastinitis, Esther Molnar, Md
A Case Of Fibrosing Mediastinitis, Esther Molnar, Md
The Medicine Forum
Introduction
Fibrosing mediastinitis (FM) is a rare disease of slowly progressive fibrosis that encases major mediastinal structures. Complications include obstruction of mediastinal vasculature, including main pulmonary arteries, which may lead to life-threatening hemodynamic compromise. In North America, the disease is usually a sequela of histoplasmosis. Because Histoplasma capsulatum (H. capsulatum) is found in the Ohio River Valley, physicians in Pennsylvania must be able to recognize and diagnose the disease.
Case Presentation
The patient is a 59 year-old female who was seen for follow-up in April 2013. She originally presented to the outpatient office in 2008 with chronic chest pain and …
A Speedy Recovery With Medical Management In A Patient With Emphysematous Gastritis, Tanvi Khurana, Md
A Speedy Recovery With Medical Management In A Patient With Emphysematous Gastritis, Tanvi Khurana, Md
The Medicine Forum
INTRODUCTION
Emphysematous gastritis is a rare and serious condition characterized by evidence of intramural air and inflammation of the gastric wall as well as systemic toxicity. It is generally caused by local infection by gas-forming organisms through a mucosal defect or via hematogenous spread from a distant focus.1 Since emphysematous gastritis has a fulminant course with a mortality rate of 60%, prompt recognition as well as early treatment are crucial.2 Here, we present a case of a 65 year-old male who presented with abdominal pain and had CT findings consistent with emphysematous gastritis. He was treated with antibiotics and had …
A Case Of Dengue Hemorrhagic Fever And The Use Of Supportive Therapy, Aishah Ali, Md, Emily Sutton, Md
A Case Of Dengue Hemorrhagic Fever And The Use Of Supportive Therapy, Aishah Ali, Md, Emily Sutton, Md
The Medicine Forum
Introduction
Dengue fever is a mosquito-bound viral illness that occurs in tropical climates. It is endemic in 110 countries.1 Fifty to three hundred and ninety million people are infected worldwide every year,2 leading to ~25,000 deaths.3 It is often an asymptomatic self-limited illness, which can present with myalgias, arthralgias, and hemorrhagic manifestations such as petechiae. In a fraction of cases, dengue fever can proceed to dengue hemorrhagic fever (DHF), which can be life threatening causing thrombocytopenia, bleeding and increased vascular permeability. Dengue shock syndrome (DSS) can then ensue, if hypotension occurs, and is fatal in >10% of patients.4
Here we …
Recurrent Cryptococcosis In A Human Immunodeficiency Virus-Negative Patient, Lillian C. Man, Md
Recurrent Cryptococcosis In A Human Immunodeficiency Virus-Negative Patient, Lillian C. Man, Md
The Medicine Forum
Introduction
Idiopathic CD4+ lymphocytopenia (ICL) is a rare disorder that can predispose otherwise immunocompetent individuals to life-threatening opportunistic infections. We present a case of a human immunodeficiency virus (HIV)-negative patient with ICL who presented with recurrent cryptococcosis.
Case Presentation
A 39-year-old Caucasian, HIV-negative male with a past medical history of stroke 13 years prior to admission and an episode of cryptococcal meningitis 18 months prior to admission presented to the hospital with generalized weakness for 7 days. The patient had a 10 pack-year smoking history and no significant environmental or occupational exposures. On admission, vital signs were significant for a …
Congenital Absence Of The Pericardium, Lillian C. Man, Md, Jaehee Kim, Md, Rakesh Gupta, Md
Congenital Absence Of The Pericardium, Lillian C. Man, Md, Jaehee Kim, Md, Rakesh Gupta, Md
The Medicine Forum
Introduction
Congenital absence of the pericardium (CAP) is an uncommon finding previously recognized only post-mortem or during surgery. However, its incidence has been on the rise with the use of multiple contemporary imaging techniques. CAP can present with paroxysmal, left-sided chest pain and should be considered in the differential diagnosis of atypical causes of chest pain. We present the case of a 50-year-old male who presented with chest pressure, symptoms of heart failure, and was found to be in atrial fibrillation in whom partial absence of the left pericardium was diagnosed.
Case Presentation
A 50 year-old African-American male presented to …
A Case Of Bilhemia: A Rare Complication Of Transjugular Intraheptic Portosytemic Shunt, Michael Zhang, Ms3, Michael Valentino, Md, Phd
A Case Of Bilhemia: A Rare Complication Of Transjugular Intraheptic Portosytemic Shunt, Michael Zhang, Ms3, Michael Valentino, Md, Phd
The Medicine Forum
Introduction
Transjugular intrahepatic portosystemic shunt (TIPS) is a common procedure used to alleviate the secondary effects of portal hypertension including uncontrolled variceal bleeding, refractory ascites, and hepatic pleural effusion (hydrothorax). There are several well-known complications of TIPS, including portosystemic encephalopathy, hemolytic anemia, hepatic ischemia, and stent thrombosis.1 In this case report we present a rare but serious complication of TIPS – bilhemia - in which bile escapes into the bloodstream through a fistula between the biliary tree and the hepatic venous system.
Case Presentation
A 56 year-old female with cirrhosis due to chronic hepatitis C presented to the hospital for …
An Uncommon Presentation Of Amyloidosis, Brandon Kujawski, Ms3, Drew Johnson, Ms3, Kushan Radadia, Ms4, Eric Feduska, Md, Robert Ford, Md, Guldeep Uppal, Md, Mariam Kabir, Md, Phd, John Stewart, Md
An Uncommon Presentation Of Amyloidosis, Brandon Kujawski, Ms3, Drew Johnson, Ms3, Kushan Radadia, Ms4, Eric Feduska, Md, Robert Ford, Md, Guldeep Uppal, Md, Mariam Kabir, Md, Phd, John Stewart, Md
The Medicine Forum
Introduction
AL amyloidosis is a rare disease, with only 1200-3200 new cases in the US per year.1 Two-thirds of patients are male; presentation typically occurs after age fifty.1,2,3 Amyloid can involve the kidneys (74%), heart (60-90%), liver (27%), peripheral nervous system (22%), and carpal tunnel (20%).3 We describe an atypical presentation of AL amyloidosis and highlight the importance of recognizing this disease in patients with systemic signs.
Sustained Achromobacter Xylosoxidans Bacteremia In A Patient With Adenocarcinoma Of The Colon, Matt Enriquez, Ms4, Andi Favini, Ms4, Kevin Curl, Md
Sustained Achromobacter Xylosoxidans Bacteremia In A Patient With Adenocarcinoma Of The Colon, Matt Enriquez, Ms4, Andi Favini, Ms4, Kevin Curl, Md
The Medicine Forum
Introduction
Achromobacter xylosoxidans is a rare cause of bacteremia; however patients with underlying illness, especially malignancies, are at increased risk of infection. Antibiotic therapy against this pathogen can be difficult owing to its inherent resistance to multiple common antibiotics.
Case Presentation
A 69-year-old male with adenocarcinoma of the colon status post right hemicolectomy and chemotherapy presented with fever and fatigue 10 days following endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement for new liver metastases. The patient had undergone partial hemicolectomy and had completed 12 cycles of adjuvant FOLFOX (leucovorin, 5-fluorouracil, and oxaliplatin) at the time of initial diagnosis. Two …
Table Of Contents, The Medicine Forum, Volume 15, 2013-2014
Table Of Contents, The Medicine Forum, Volume 15, 2013-2014
The Medicine Forum
Table of Contents, The Medicine Forum, Volume 15, 2013-2014
From The Editors, Harkirat Singh, Md, Michael A. Valentino, Md, Phd
From The Editors, Harkirat Singh, Md, Michael A. Valentino, Md, Phd
The Medicine Forum
We are proud to publish the 15th issue of The Medicine Forum. Since its inception, this journal has provided a medium for medical students and housestaff to share their scholarly pursuits and clinical experiences with the Jefferson community. It has served as a platform both for those pursuing careers in academic medicine as well as those wishing to share their personal experiences with a larger audience. This year we are introducing a new section called Clinical Images which will showcase interesting physical exam findings and radiographic images accompanied by brief patient vignettes. We have been fortunate to have received numerous …
From The Desk Of The Residency Program Director, Gretchen Diemer, Md, Facp
From The Desk Of The Residency Program Director, Gretchen Diemer, Md, Facp
The Medicine Forum
Welcome to the Forum!
We have experienced another wonderful year in the Jefferson Internal Medicine Residency Program! Our program continues to attract the best and brightest medical students who over three years become outstanding clinicians, accomplished researchers and compassionate physicians. Residency training is increasingly complex, with competing demands compressing their work into fewer hours. I am consistently impressed with the camaraderie among our housestaff—they not only take care of patients, but they take care of each other. It is something that sets our program apart from others and is something of which I am incredibly proud.
Download Entire Issue Of The Medicine Forum, Volume 16, 2014-2015
Download Entire Issue Of The Medicine Forum, Volume 16, 2014-2015
The Medicine Forum
Download entire issue of The Medicine Forum, Volume 16, 2014-2015
Pneumothorax Ex Vacuo In A Patient With Malignant Pleural Effusion After Pleurx Catheter Placement, Meera Bhardwaj, Ms4, Loheetha Ragupathi, Md
Pneumothorax Ex Vacuo In A Patient With Malignant Pleural Effusion After Pleurx Catheter Placement, Meera Bhardwaj, Ms4, Loheetha Ragupathi, Md
The Medicine Forum
Introduction
Pneumothorax ex vacuo (“without vaccuum”) is a type of pneumothorax that can develop in patients with large pleural effusions. Unlike spontaneous or tension pneumothoraces, pneumothorax ex vacuo does not require chest tube placement. Careful recognition of this type of pneumothorax may save patients and physicians from an unnecessary procedure, and limit patient risk of infection, bleeding and further lung injury.