Hematology Commons^™

A Stroke That Wasn’T: Thrombotic Thrombocytopenic Purpura Presenting With Isolated Neurologic Deficits, Renuka Mahatara, Sahil N. Parikh, Amelia Piccone, Merid Moqattash, Nicole Ryan, Dmitri Zbarsky

South Atlantic Division GME Research Days 2026

No abstract provided.

Upper Respiratory Tract Infection Leading To A New Diagnosis Of Sweet Syndrome And Monoclonal Gammopathy Of Unknown Significance, Nidhi Rawat, Meron Gebrehiwot, Jason Raw, Jeyaprakash Ramachandran

HCA Healthcare Journal of Medicine

Background

We present a rare case of Sweet syndrome with underlying monoclonal gammopathy of unknown significance (MGUS) which initially presented as upper respiratory tract infection.

Case Presentation

A 52-year-old woman presented with a complaint of sore throat for 6 days, productive cough and fever for 5 days, and red, pruritic, circular, tender rashes on face, arms and trunk for 2 days. There was a past history of similar self-limiting rashes presenting intermittently for 1.5 years. She also reported to be taking tablet ibuprofen, as required for the past 1-2 years, for cervical spondylosis. On integumentary examination, widespread, red, tender, annular …

A Complex Case Of A Large Fibroid Uterus Compressing The Inferior Vena Cava Causing Recurrent Deep Vein Thrombosis And Pulmonary Embolisms, Jessica Gil, Jessica Klingensmith, Lauren Hendrix, Patrick J. Stocker, Olugbenga Oyesanmi

HCA Healthcare Journal of Medicine

Background

Uterine fibroids have been found to increase the risk for venous thromboembolism. There have been other case reports linking large uterine fibroids, pulmonary embolisms, and deep vein thrombosis (DVT) together due to compression of blood vessels and increased venous stasis. This case report will discuss a case of a large fibroid uterus compressing the inferior vena cava causing a patient with few risk factors to have recurrent DVTs and pulmonary embolisms.

Case Presentation

The patient was a 35-year-old woman who presented with repeated unprovoked thrombosis episodes. The patient had a full workup after the first episode of DVT and …

Complications And Management Of Idiopathic Multicentric Castleman Disease, Kavanya Feustel, Jacob W. Keeling, Olivia Makos, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Background

The pathophysiology of idiopathic multicentric Castleman disease (iMCD) is poorly understood compared to the other subtypes of MCD, which has contributed to limited treatment options and poor prognosis for iMCD patients. The pathogenesis of iMCD is thought to be mediated in part by dysregulation of interleukin (IL)-6.

Case Presentation

We present a case report of a 39-year-old Caucasian man with siltuximab-refractory iMCD. He presented with severe lower extremity lymphedema and wounds. His disease progressed through standard-of-care siltuximab. Due to his severe disease-related morbidity, he contracted recurrent infections, often complicated by sepsis. Ultimately, he required a left lower extremity amputation. …

Hemophagocytic Lymphohistiocytosis In A Critically Ill Patient: A Case Report Of A Potentially Fatal Entity, Ali Khreisat, Inna Mikaella Sta Maria, Giovi Grasso-Knight, Meghan Mansour

HCA Healthcare Journal of Medicine

Background

Hemophagocytic lymphohistiocytosis (HLH) is a non-neoplastic proliferation and macrophage activation that induces cytokine-mediated bone marrow suppression and features of intense phagocytosis in the bone marrow and liver, leading to multi-organ dysfunction and ultimate failure. The diagnosis of HLH in an intensive care setting is challenging, and it is associated with high morbidity and mortality. HLH-94 is the standard protocol for treatment, consisting of dexamethasone and chemotherapy like etoposide.

Case Presentation

We present the case of a 73-year-old woman who had a prolonged hospitalization for vomiting, diarrhea, and dehydration. Her conditions were complicated by acute refractory pancytopenia on the 12th …

Hemophagocytic Lymphohistiocytosis Due To Ehrlichiosis: A Case Series, Ajay Iyer, Mattias D'Anna, Shruti Verma, Thomas Pritchard, Vladimir Begilman, Himal Bajracharya, Kaveh Naemi

HCA Healthcare Journal of Medicine

Background

Hemophagocytic lymphohistiocytosis (HLH) is an immunologic syndrome characterized by excessive inflammation and tissue injury due to uncontrolled activation of the phagocytic system. The underlying mechanism is a lack of downregulation of activated macrophages and lymphocytes by natural killer and T cells. Unfortunately, the diagnosis is often delayed or missed due to the rarity of the disease, decreased awareness, and clinical picture variability. Ehrlichiosis is becoming a more prevalent tick-borne illness in endemic regions and a relatively uncommon but increasingly considered cause of HLH.

Case Presentation

We describe the cases of 2 patients diagnosed with secondary HLH as per the …

Investigating The Effects Of Nosocomial Clostridioides Difficile Infection Among Acute Leukemia Patients: Insights From The 2020 National Inpatient Sample, Zubair Hassan Bodla, Mariam Hashmi, Fatima Niaz, Umer Farooq, Muhammad Jahanzeb Khalil, Farhan Khalid, Kipson Charles, Christopher L. Bray

HCA Healthcare Journal of Medicine

Background

Rising nosocomial Clostridioides difficile infections pose high risks, especially for immunocompromised leukemia patients, necessitating targeted research to enhance patient care and outcomes.

The objective of this study was to investigate the impact of nosocomial Clostridioides difficile infections (CDI) on patients hospitalized with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

Methods

Our study was a retrospective analysis of adult patients hospitalized with a primary diagnosis of ALL or AML, using the Nationwide Inpatient Sample (NIS) database for 2020. Primary outcomes included the incidence of nosocomial CDI and all-cause inpatient mortality. Secondary outcomes included hospital length of stay, resource …

Pancytopenia And Disseminated Varicella-Zoster Virus In A Patient With T-Cell Lymphoblastic Lymphoma In Maintenance Phase Of Treatment: A Case Report, Kathryn Jordan, Paul Bryant, Clinton Carroll, Jennifer Domm

TriStar Division GME Research Day 2024

No abstract provided.

Rapid Hepatomegaly From Ruxolitinib Discontinuation Syndrome, Ryan Jansen Van Rensburg, Shayna Hale, Anna Calara, Kulveer Dabb, Uday Dandamudi, Parth Desai

HCA Healthcare Journal of Medicine

Introduction

Ruxolitinib (RUX) is a Food and Drug Administration-approved Janus Kinase (JAK) inhibitor shown to be effective in improving hypercatabolic symptoms and splenomegaly in patients with myelofibrosis (MF). RUX therapy provides symptomatic benefits for MF patients but is often discontinued for various reasons including worsening cytopenias. Ruxolitinib Discontinuation Syndrome (RDS) involves an acute cytokine-storm rebound phenomenon that can manifest as an acute relapse of symptoms, worsening splenomegaly, respiratory distress, systemic inflammatory response syndrome, or disseminated intravascular coagulopathy.

Case Presentation

We present the case of a patient with JAK2-positive post-polycythemia vera MF, whose RUX therapy was discontinued due to an active …

Anti-Factor Xa Level Monitoring For Enoxaparin Prophylaxis And Treatment In High-Risk Patient Groups, Lucie Sikes, Kipson Charles, Abigail Antigua, Rima Patel, Selina Imboywa, Pheba Cherian

HCA Healthcare Journal of Medicine

Monitoring anti-factor Xa levels is a controversial topic in the inpatient setting due to resource utilization and unclear conditional guideline recommendations regarding this practice. Enoxaparin dosing in certain high-risk patient populations such as those with low body weight, obesity, renal insufficiency, and pregnancy has not been determined. The objective of this review was to assess the safety and efficacy of enoxaparin monitoring via anti-factor Xa levels in high-risk patient populations.

The PubMed database was searched for articles related to low-molecular-weight heparin monitoring. Randomized controlled trials and meta-analyses that evaluated the safety and efficacy of enoxaparin prophylaxis and treatment in patients …

Blastic Plasmacytoid Dendritic Cell Neoplasm, Jacquelyn Medina, Adam Chahine, Courtney Bernett, Karthik Krishnamurthy

South Atlantic Division GME Research Day 2023

No abstract provided.

Utilization Of Patient-Controlled Analgesia Reduces Length Of Stay Of Sickle Cell Crisis Hospitalizations, Brett M. Prestia, Talha Ramzan, Catherine Waldron, Ameer Malik, Robert M. Pallay, Candace R. Murbach, Mike Flynn, Eric Shaw Phd, Abdullah Kutlar, Daniel Lowe

HCA Healthcare Journal of Medicine

Background

Sickle cell crisis hospitalizations are emotionally and financially burdensome to patients and healthcare systems, and processes to decrease the frequency or length of stay of these crises should be examined.

Methods

This is a multicenter retrospective hospital record review of sickle cell crisis hospitalizations as defined by ICD-10 codes (D57.1-4), from January 2016 through December 2019, examining inpatient medication administration records and length of stay among admitted adults aged 18–65 years. Patient controlled analgesia orders using morphine, hydromorphone, fentanyl and/or merperidine at any point of an admission (n=188) were compared to admissions without any patient-controlled analgesia orders (n=2,159). The …

May-Thurner Compressive Syndrome Unmasked By Rapid Weight Loss, Hesham A. Hassan, Jan-Paul Sambataro, James C. Abraham

HCA Healthcare Journal of Medicine

May-Thurner Syndrome (MTS) is an anatomical syndrome characterized by a predisposition to clot formation when there is compression of the left iliac vein by the right iliac artery. In this case, we discuss an atypical presentation of MTS in a young male after rapid weight loss. The patient was admitted for an unprovoked massive proximal deep vein thrombosis (DVT) after a two-hundred-pound weight loss during the preceding six-month period. Treatment involved mechanical thrombectomy by interventional radiology, initiation of apixaban and recommended follow up with vascular surgery for angioplasty instead of immediate stent placement.

A Case Of Rare Subtype Of Multiple Myeloma: Secondary Plasma Cell Leukemia, Chandra Sanwal, Aftab Mahmood, Michael Bailey, Krutika Patel, Antonio Guzman

HCA Healthcare Journal of Medicine

Plasma cell leukemia is a rare, aggressive form of multiple myeloma with the presence of circulating plasma cells in the peripheral blood. There are two types of plasma cell leukemia, primary and secondary, depending on if there was previous evidence of multiple myeloma. The diagnostic criterion of plasma cell leukemia is based on a percentage (>20%) or an absolute number of (≥2 x 109/L) plasma cells in the peripheral circulation. We present the clinical course of a rare case of secondary plasma cell leukemia in a patient from the time of initial diagnosis of multiple myeloma, its remission period …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …

Investigation Of A Peculiar Case Of Childhood Lymphadenopathy, Chade Aribo, Alonso Al, Allison Woodall, Tommy Y. Kim

HCA Healthcare Journal of Medicine

Introduction: Lymphadenopathy is a common physical finding often associated with an infectious etiology. We present a case of a patient with generalized cervical and supraclavicular lymphadenopathy diagnosed with a rare malignancy. Health care providers should be aware of some uncommon historical or physical examination findings that warrant further investigation.

Clinical Findings: A 16-year-old female presented to the emergency department with 3 days of a fever, congestion and sore throat with swelling around the jaw. Her physical examination findings included bilateral mandibular swelling and generalized cervical lymphadenopathy with palpable supraclavicular lymph nodes.

Outcomes: Complete blood count showed pancytopenia with a white …

Convalescent Plasma In Covid-19, Ranjit S. Banwait, Joshua K. Salabei, Troy J. Fishman, Uma G. Iyer

HCA Healthcare Journal of Medicine

The recent pandemic of SARS-CoV-2, which causes novel coronavirus disease 2019 (Covid-19), has had devastating impact on a global and national scale. In order to overcome this outbreak it is imperative we find treatments that are safe and effective. To date, no definitive treatment is available that can curtail the spread of this viral syndrome. Convalescent plasma (CP) is one such option that has repeatedly served as an important tool in treatment of various bacterial and viral infections, especially in the setting of no specific antimicrobial or vaccination against an infectious disease. Herein, we review the history of CP, prior …

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.