Internal Medicine Commons^™

Flash Pulmonary Edema: A Case And Review Of Left Ventricular Non-Compaction Cardiomyopathy, Paula J. Watts, Oliver S. Garbo, Wendy Barrett, Michael Kopstein, Ryan Maybrook, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Left ventricular non-compaction cardiomyopathy is an uncommon type of cardiomyopathy caused by malformation of the myocardium during embryogenesis. This results in trabeculations within the ventricular wall that can affect the left and, less commonly, right ventricles. Presentation ranges from clinically asymptomatic to life-threatening arrhythmias. It is a rare and relatively unknown form of cardiomyopathy, though thought to be underdiagnosed. Prevalence is increasing due to improvements in imaging and awareness. Management is similar to that of other cardiomyopathies including angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers, diuretics, automatic implantable cardioverter defibrillator placement and cardiac transplantation. We present a case of a …

Low Dose Clenbuterol Toxicity: Case Report And Review Of Literature, Kenneth Lan, Adarsh Saheba, Paul Mathew

HCA Healthcare Journal of Medicine

Clenbuterol is a long-acting β-agonist used in oral and inhaled form for asthma treatment outside the U.S. and in veterinary medicine within the U.S. It is also used off-label for anabolic effects worldwide. Toxicity with clenbuterol is increasingly seen in U.S. hospitals, primarily in younger individuals using the drug for competitive athletics or bodybuilding. We present a case of a young patient who presented after an intentional overdose and discuss the relevant literature. Presentations do not correlate with the dosage ingested. Signs and symptoms can range from simple nausea to myocardial ischemia, rhabdomyolysis and cardiogenic shock. Treatment of overdose is …

Substance Use Service Availability In Hiv Treatment Programs: Data From The Global Iedea Consortium, 2014-2015 And 2017, Angela M. Parcesepe, Kathryn Lancaster, E. Jennifer Edelman, Raquel Deboni, The Foundation For Aids Research, Bangkok, Thailand, Lukoye Atwoli

Internal Medicine, East Africa

Background: Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes.

Methods: We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014–2015 …

Erythema Annulare Centrifugum: A Rare Skin Manifestation Of Hashimoto Thyroiditis, Palwasha Jalil, Sadia Masood, Saira Fatima

Section of Internal Medicine

Erythema annulare centrifugum (EAC) is an unusual skin condition appearing as recurrent erythematous annular eruptions associated with autoimmune disorders, infections, and various neoplastic conditions. We present a very rarely reported association of EAC with Hashimoto thyroiditis (HT) in a young male. A 26-year-old male recently diagnosed as case of HT presented in the dermatology clinic with nine-month history of non-itchy persistent annular lesions on the body. The morphology and biopsy of lesions confirmed the diagnosis of EAC. HT is a part of the spectrum of autoimmune thyroid diseases with its own specific cutaneous manifestations. Our case also depicts the impact …

Hamman-Rich Syndrome: A Diagnosis Of Exclusion In The Covid-19 Pandemic., Qian Zhang, Ahmad Raza, Vincent Chan, Artem Minalyan, John Madara, Md

Abington Jefferson Health Papers

Hamman-Rich syndrome is a rapidly progressive interstitial lung disease with acute respiratory distress syndrome physiology. It carries a grave prognosis and a high early mortality rate. It is often distinguished from other similar pulmonary pathologies based on the clinical course, laboratory findings, bronchoalveolar lavage testing, and pathology report. We detail a 77-year-old lady with no prior pulmonary disease, smoking history, or occupational and environmental exposures present to the emergency department found to be in acute hypoxic respiratory failure with impressive progressive radiographic findings. The presumptive diagnosis of Hamman-Rich syndrome was made based on a combination of factors after ruling out …

Serum Ammonia And Folate Levels: Opportunities For High Value Care, R. Benson Jones Jr., Md, Sean Dikdan, Md, Bracken Babula, Md

The Medicine Forum

High value care encompasses a variety of principles including ordering tests with high diagnostic yield, while reducing low value practice.

Refusing To Be Labeled, Jennifer Perugini

The Medicine Forum

Refusing to be Labeled

Case Report Of E-Cigarette Associated Lung Injury In A Health Female, Mario Fonseca-Paricio, Md, Alan Gandler, Md, Boyd Hehn, Md

The Medicine Forum

This is a case of a woman presenting with four days of diarrhea and dyspenea found to have E-cigarette or vaping-associated lung injury (EVALI)

A Case Report Of Bullous Subconjunctival Hemorrhag In Adenoviral Conjunctivitis, Sean Haynie, Jesse Johnson, Md

The Medicine Forum

A 78-year-old female with a past medical history of optic neuropathy and atrial fibrillation on warfarin presented with two weeks of progressive bilateral eye redness, swelling, pain, and blurry vision.

A Case Report Of Tragaxofusp Causing Severe Tumor Lysis Syndrome In A Patient With Blastic Plasmacytoid Dendritic Cell Neoplasm, Shuwen Lin, Md, Alice Wang, Md

The Medicine Forum

The patient was an 83-year-old male without significant past medical hsitory who presented to his primary care physician with several days of generalized malaise

Exploring The Adverse Effects Of Car-T Therapy: A Cases Report Of Potential Minoca In Car-T, Danielle Verghese, Pgy-1, Adam Binder, Md, Colin Thomas, Md

The Medicine Forum

A 48-year-old man with a history of Stage IV Diffuse Large B-Cell Lymphoma refractory to R-CHOP alternating with high-dose methotrexate and cytarbine, craniospinal irradiation, and haploidentical stem cell transplant, underwent CD 19-directed CAR-T.

A Case Report Of Hemophagocytic Lymphohistiocytosis Secondary To Disseminated Tuberculosis, Shuwen Lin, Md, Christoher Terry

The Medicine Forum

A 72-year-old woman with past medical history of hypertention and type 2 diabsetes presented to the emergency department for one day history of fevers, poor oral intake, and fatigue.

From The Desk Of The Residency Program Director, Emily Stewart, Md, Facp

The Medicine Forum

It has been a historic year for the Nation, City of Philadelphia and teh Jefferson Internal Medicine Residency Program. We have eperienced many health care crises starting with the closure of the historic Philadelphia hospital, Hahnemann. We welcomed residents form this program as part of the Jefferson Family and integrated many patients into our practices.

From The Editors, Eitan Frankel, Md, Guy Katz, Rachel Redfield, Navdeep Sangha, Michael Weintraub, Randi Zukas

The Medicine Forum

We are delighted to present you with the 21st annual edition of The Medicine Forum.Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty.

Table Of Contents: The Medicine Forum Volume 21, 2019-2020

The Medicine Forum

Table of Contents: The Medicine Forum Volume 21, 2019-2020

An Unusual Treatment For Chronic Myelomonocytic Leukemia, Eric Warner, Msiii, Neil Palmisiano, Md

The Medicine Forum

A 76-year-old female with a past medical history of an extraosseous chondrasrcoma status-post-resection thirty years prior, hypertension, hyperlipidemia, and hypothyroidsimm presented to her primary care physicial with fatigue, two weeks of dyspnea on exertion, lightheadedness, and nausea.

Diagnosing Non-Hfe Hereditary Hemochromatosis, Brian Park, Md, Naman Upadhyay, Md, Dina Halegoua-Demarzio, Md

The Medicine Forum

A 63-year-old Caucasian female presented for evaluation of abnormal bile duct appearance on ERCP after being diagnosed with gallstone pancreatitis, duodenal ulcers and gastritis at another hospital.

Pericardial Effusion With Tamponade Physiology In A Patient With Multiple Myeloma, Sairamya Bodempudi, Md, Rukaiya Bashir-Hamidu, Md, Preya Simlote, Md, Shuwen Lin, Md, Philip Margiotta, Md, Tina Boortalary, Md, Gregary D. Marhefka, Md

The Medicine Forum

A 78-yeaer old African American female with a past medical history of IgA Kappa Multiple Myseloma was transfered to the Cardiovascular Intensive Care Unit (CVICU) at Thomas Jefferson University Hospital (TJUH) after being diagnosed with a pericardial effusion with tamponade physiology at an outside hospital.

An Approach To Refractory Hypoxemia, Daniel Garrido, Md, Evan Nardone, Md, Mark Mallozzi, Md

The Medicine Forum

A 74-year-old female with no significant pulmonary history presented as a transfer from an outside hospital for persistent refractory hypoxemia.

Bilateral Intercostal Lung Herniations: A Rare Incidental Finding In A Dyspneic Patient, Jillian Cooper, Md, Christine Kurian, Md

The Medicine Forum

A 63-year-old man with a past medical history of chronic obstructive pulmonary disease (COPD), stage IV sarcoidosis on 3-4 liters of home oxygen and chronic prednisone, moderate aortic stenosis, and a prior aspergilloma for which he had a left upper lobe lung resection presented to the hospital with two weeks of worsening shortness of breath.