Internal Medicine Commons^™

Cancer Of Unknown Primary With Squamous Cell Carcinoma Phenotype Presenting As Isolated Axillary Mass, Nicole Liang, Mohamed Ashal, Lynne J. Goebel

Internal Medicine

Cancer of unknown primary (CUP) is a rare metastatic malignancy where no primary tumor can be found. We report the case of a 71-year-old female with a strong family history of breast cancer presenting with isolated axillary lymphadenopathy after a tick bite. A biopsy of the axillary mass revealed poorly differentiated squamous cell carcinoma and after extensive evaluation, she was diagnosed with metastatic squamous cell carcinoma with unknown primary tumor. We present this case because of the role of confounding history complicating her initial diagnosis and bringing awareness to a rare disease.

Musical Hallucinations In An Elderly Female With Hearing Loss, Jacqueline Cavendish, Lynne J. Goebel

Internal Medicine

Musical hallucinations (MH) are rare auditory phenomena in which patients perceive music without a known source. Risk factors for MH include hearing loss, older age, female gender, epilepsy, and certain medications. This case report details the presentation, diagnosis, and treatment of an 82-year-old woman who developed MH following the onset of hearing loss. Despite treatment attempts with gabapentin, quetiapine, and donepezil, the symptoms persisted, demonstrating the difficulty in treating this condition.

Atypical Lyme Disease Rash: A Case Report, Selena Khanna, Lynne J. Goebel

Internal Medicine

Lyme disease (LD), caused in the United States primarily by Borrelia burgdorferi sensu lato, is a tick-borne illness characterized by a spectrum of clinical manifestations depending on the stage of illness. Most clinicians are familiar with the classic bullseye appearance of the erythema migrans (EM) rash that occurs inthe early stage of the disease. However, many providers may not be aware of alternate appearances for the rash. This paper reports the case of a 69-year-old female with LD, exhibiting an atypical rash with purplish discoloration that was devoid of an outer ring or central clearing. In geographic areas with a …

Written Communication From Pharmacy Benefit Managers: Is It Helpful?, Lily G. Cessna, Lynne J. Goebel

Internal Medicine

Introduction: Physicians are experiencing greater burnout due to excessive time spent on paperwork. Pharmacy benefit managers (PBMs) are adding to this problem by sending excessive mail to physicians. This study examined these mailed communications to determine their frequency and if the physician acted upon them. We hypothesized that few of these mailings would be helpful to the physician.

Methods: From July 2021 to May 2023, we collected all written communications from PBMs to a single geriatrics outpatient physician. We sorted this information by specific PBM, by communication category, if it resulted in an intervention, and if communications were repeated.

Results: …

A Rare Metastatic Primary Rectal Melanoma In A Geriatric Male, Onyinye Ugonabo, Mujtaba Mohamed, Ebubechukwu Ezeh, Joseph Simmons, Jonathan Cuda, Shima Ghavimi

Internal Medicine

Primary rectal melanoma (PRM) is an uncommon malignancy whose etiology remains unknown. Most patients present with rectal bleeding. Distant metastasis is commonly seen in the lung and liver. The incidence rates for locoregional lymph node metastases on initial presentation are almost 60%. Histology and immunochemistry are useful and are the gold standard for diagnosis. The prognosis is very poor due to the late presentation of patients. Optimum surgical treatment remains controversial. Abdominoperineal resection was considered traditionally but over time, has been found to have no survival benefit. Current literature and studies, therefore, recommend wide local excision. The beneficial effects of …

Sclerosing Mesenteritis: A Rare Cause Of Abdominal Pain, Said Sharawi, Vincent A. Graffeo, Lynne J. Goebel

Internal Medicine

Sclerosing mesenteritis (SM) is a rare inflammatory fibrotic disease of the small intestine mesenteric fat often discovered incidentally on a CT scan. Clinical manifestations depend on the mass effect on the viscera and vessels. The most common symptoms are abdominal pain, bloating, and nausea. SM occurs predominantly in Caucasian men, during the fifth to seventh decades of life. We present a 69-year-old woman with SM whose symptoms were thought to be from irritable bowel syndrome. A 69-year-old female with a history of fibromyalgia presented with recurrent bouts of abdominal pain across her mid-abdomen lasting 30 minutes to an hour associated …

Sporadic Creutzfeldt-Jakob Disease After Receiving The Second Dose Of Pfizer-Biontech Covid-19 Vaccine, Andrea J. Folds, Melanie-Belle Ullrich, Sann Htoo, Anjeza Chukus

Internal Medicine

No abstract provided.

A Novel Backward Stepwise Logistic Regression And Classification And Regression Tree Model To Predict 180-Day Clinical Outcomes In Hepatitis B Virus-Acute-On-Chronic Liver Failure Patients, Shima Ghavimi

Internal Medicine

As the era of precision and personalized medicine is gaining exponential positive gain in the field of medicine, there is a positive shift towards a more evidence-based patient care approach for patients with hepatological diseases. One factor that is crucial in any physician’s decision-making efforts involves the application of novel innovative approaches that can enhance predicting survival outcome. Acute-on-chronic liver failure (ACLF) is a perfect example of how liver can rapidly deteriorate, and the hepatitis B virus (HBV) is one crucial culprit. Patients can experience organ failure that leads to their mortality, and in this article the authors clearly described …

A Randomized Open-Label Study Of Two Methods Of Proton Pump Inhibitors Discontinuation, Emily Hendricks, Aman Ajmeri, Monider M. Singh, Milliejoan Mongalo, Lynne J. Goebel

Internal Medicine

Background: Proton pump inhibitors (PPIs) are effective in treating gastroesophageal reflux disease (GERD). Unfortunately, they are often inappropriately prescribed and long-term use has potential adverse effects. A single best method for discontinuation of PPIs does not currently exist. The objective of this study was to determine if there is a significant difference in successfully discontinuing PPI use at 12 months between patients discontinuing abruptly or tapering first.

Methodology: We conducted a randomized trial with 38 patients diagnosed with GERD. We collected six weekly and then monthly surveys of symptoms based on the Dyspepsia Symptom Severity Index. Chart review at 12 …

Can Charcoal Improve Outcomes In Covid-19 Infections?, Zeid J. Khitan, Imran Khawaja, Maurice A. Mufson, Juan R. Sanabria, Nader G. Abraham, Stephen J. Peterson, Uma Sundaram, Joseph I. Shapiro

Internal Medicine

COVID-19 infection causes considerable morbidity and mortality, especially to those who are aged, have impaired renal function and are obese. We propose to examine the potential utility of oral activated charcoal with the hypothesis that such treatment would lower absorption of microbiome derived toxins and ameliorate systemic oxidant stress and inflammation.

Post-Influenza Vaccine Subdeltoid Bursitis, Marenda Jenkins, David Rupp, Lynne J. Goebel

Internal Medicine

A 61-year-old female presented three months following an influenza vaccination with ongoing pain since the injection and was diagnosed by MRI with subdeltoid bursitis. The patient received a short course of prednisone and several months of physical therapy before returning to pain-free function. The primary reason for injection-related subdeltoid bursitis is improper administration. It is a preventable issue, and improved training of healthcare workers on proper vaccine administration may decrease its occurrence.

A Quality Intervention To Reduce Telemetry, Alina Polonsky Md, Abdullah Alcharif Md, Andrew Maiolo Md

Internal Medicine

No abstract provided.

A Decerebrating Female: A Rare Presentation Of Acute Disseminated Encephalomyelitis Due To Measles, Natasha Del Rio, Yordan Orive, Andres Sobrado, Ruben Cabrera, Ilde Manuel Lee, Troy Hoang, Sherard Lacaille, Ricardo Garcia-Rivera, Robert Hernandez

Internal Medicine

No abstract provided.

Phlegmasia Cerulea Dolens In May Thurner Syndrome: A Threat To Life & Limb, Matt Mcmaster, Rage Geringer Md, Gregory Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

Bradycardia In The Setting Of Gastric Sarcoidosis, Kameron Black Mph, Michelle Levine Do, Rage Geringer Md, Gregory Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

Adrenocortical Carcinoma: A Stressful Diagnosis, Shabnam Khoie Do, Dmitriy Scherbak Do

Internal Medicine

Introduction: Adrenocortical carcinoma (ACC) is a rare and biologically aggressive malignancy. The incidence of ACC is between 0.7-2 cases per million, accounting for 0.05-2% of all malignant tumors. Cortisol-producing carcinomas are the most common, with clinical features consistent with hypercortisolism: refractory hypertension, glucose intolerance, and central obesity. We present a case of a 75-year-old male with a cortisol-secreting variant of adrenocortical carcinoma.

Case Description: A 75 year-old male with a prior medical history significant for refractory hypertension on multiple anti-hypertensives including hydrochlorothiazide, type two diabetes mellitus, and untreated obstructive sleep apnea, presented to the emergency department with a blood pressure …

Severe Malaria Due To Plasmodium Falciparum, Hamid Hussaini, Rage Geringer Md, Gregory Hicks Md, Oliwier Dziadkowiec

Internal Medicine

No abstract provided.

A Five Chambered Heart, George Hanna, Javad Savoj, Syed Iftikhar, Scott Kubomoto, Patrick Hu

Internal Medicine

No abstract provided.

Catch 22 : To Anticoagulate Or Not To Anticoagulate, Muhammad Madkour, Patrick Hu

Internal Medicine

No abstract provided.

Assessment Of Guideline Recommended Anti-Coagulation Rates For Atrial Fibrillation In An Outpatient Resident Clinic, Kanav Gupta Md, Emily Langnas Do, Zahra Khaled, Travis Tagami Do, Alexandra Halalau Md

Internal Medicine

No abstract provided.

Giant 75mm Intracranial Aneurysm Masquerading As Primary Malignancy, Andrew W. Hwang, Satvir Dhillon Md, Remus Popa

Internal Medicine

No abstract provided.

Always Remember To Floss... Or Else, Arunmozhi (Sankavi) Aravagiri Md, Muhammad Zain Md, Rajesh Gulati Md

Internal Medicine

No abstract provided.

How Deep Is Too Deep?, Dietrich Schlueter Md, Asma Jamil Md, Ibrahim Talab, Samia Faiz, Scott Kubomoto Md

Internal Medicine

No abstract provided.

Cervical Osteomyelitis: Unique Presentation And Fatal Outcome, Asma Jamil Md, Ayesha Jamil Md, Scott Kubomoto Md, Liliana Crisan Md

Internal Medicine

No abstract provided.

Calcium Alkali Thiazide Syndrome, Mehboob A. Rehan Md, Asma Rashid Md, Reema Singh Md, Gabutti Cristina, Luma Mohsin Md, Tausha Allen Md, Paul Stanford Md, James Thomson Md

Internal Medicine

No abstract provided.

Creutzfeldt Jakob Disease: Progressive Neurological Decline, Christine Fayad Md, Scott J. Anderson, H. Alex Akhondi Md

Internal Medicine

No abstract provided.

A Case Of Transient Complete Av Block Caused By Infective Endocarditis With Abiotrophiadefectiva, Jung Yoon Do, Wilco Civil Sr, Urvish Patel, Jermaine Ekobena, Arun Abraham, Michael Strobbe

Internal Medicine

No abstract provided.

Pancreatic Cancer: Leading To Failure Of Rivaroxaban As An Anticoagulant, Pratikkumar Vekaria Md, Chandrika Raiyani, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

Vascular Thromboembolism (VTE) is seen with hypercoagulable state and it can be a reason of significant morbidity and mortality. Cancer is considered as one of the most common causes of hypercoagulability and developing VTE. Since novel oral anticoagulants (NOAC) have been introduced in market for VTE prophylaxis and treatment, their use have been increased significantly as they are easy to use without episodic monitoring. Rivaroxaban is one of the commonly used NOACs and some of studies have shown its good efficacy for VTE.

A Unique Presentation Of Scurvy In The Modern Era, Anita Bhagavathula Do, Joanna Linsteadt Md, Sonam Jaggi Md

Internal Medicine

No abstract provided.

Nasal Crohn's: Rare But Real Possibility, Pratikkumar Vekaria Md, Johnnie Mao Md, Ravis Patel Md, Devin Vaishnani Md, Tejas Raiyani Md

Internal Medicine

Crohn’s disease(CD) is an autoimmune IBD that can occur anywhere along GI tract. Its pathology show transmural granulomatous inflammation that can include all layers of GI lining. Extra-intestinal manifestations can be seen in multiple organ systems like skin, joints, eyes, and mouth. These symptoms are common in patient involving large intestine compare to involving only small-intestine. Nasal involvement is rare with CD and very few cases have been reported so far.