Internal Medicine Commons^™

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …

Cardiometabolic Health: Actionable Prevention Strategies And New Care Models, Omar Leonards, David Aguilar

School of Medicine Faculty Publications

No abstract provided.

Home Blood Pressure Telemonitoring Technology For Patients With Asymptomatic Elevated Blood Pressure Discharged From The Emergency Department: Pilot Study, Karen C Tran, Meagan Mak, Laura M Kuyper, Jesse Bittman, Birinder Mangat, Heather Lindsay, Chad Kim Sing, Liang Xu, Hubert Wong, Martin Dawes, Nadia Khan, Kendall Ho

Faculty, Staff and Student Publications

BACKGROUND: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. …

Transmembrane Stem Factor Nanodiscs Enhanced Revascularization In A Hind Limb Ischemia Model In Diabetic, Hyperlipidemic Rabbits, Eri Takematsu, Miles Massidda, Gretchen Howe, Julia Goldman, Patricia Felli, Lei Mei, Gregory Callahan, Andrew D Sligar, Richard Smalling, Aaron B Baker

Faculty, Staff and Student Publications

Therapies to revascularize ischemic tissue have long been a goal for the treatment of vascular disease and other disorders. Therapies using stem cell factor (SCF), also known as a c-Kit ligand, had great promise for treating ischemia for myocardial infarct and stroke, however clinical development for SCF was stopped due to toxic side effects including mast cell activation in patients. We recently developed a novel therapy using a transmembrane form of SCF (tmSCF) delivered in lipid nanodiscs. In previous studies, we demonstrated tmSCF nanodiscs were able to induce revascularization of ischemia limbs in mice and did not activate mast cells. …

Severe Dysphagia With Eosinophilic Esophagitis Pattern Of Injury Related To Pembrolizumab Therapy, James S Barnett, Kevin K Yu, Xavier Rivera Rivera, Asmeen Bhatt

Faculty, Staff and Student Publications

While immune checkpoint inhibitor (ICI) therapies are effective treatments for many cancers, ICI therapies are associated with immune-related adverse events. We present a 67-year-old man with non-small cell lung carcinoma, who developed severe dysphagia with biopsies from an esophagogastroduodenoscopy showing histopathology consistent with eosinophilic esophagitis while on ICI maintenance therapy with pembrolizumab. The patient's symptoms worsened despite standard therapy. However, he had complete resolution of dysphagia symptoms once pembrolizumab was discontinued. While immune-related adverse events affecting the gastrointestinal system are increasingly recognized, ICI-associated eosinophilic esophagitis is a rare entity.

Managing Diffuse Alveolar Hemorrhage In A Critical Care Setting, Yong-Chan Kim, Jessica Marcela Daza, Juan C. Naranjo, Timothy Heath

Research Symposium

Background: Diffuse alveolar hemorrhage (DAH) is defined as disruption of the alveolar-capillary basement membrane, causing bleeding into the alveolar spaces. It is one of the rarest complications in systemic lupus erythematosus (SLE) and life-threatening conditions. Symptoms include shortness of breath, cough, fluctuating fever, and rarely hemoptysis. Complications include acute respiratory distress syndrome. The test of choice for diagnosis is bronchoalveolar lavage (BAL). The hallmark is that BAL aliquots are progressively more hemorrhagic. CT-chest shows ground glass or consolidative opacities that are usually diffuse and bilateral nonspecific. There is no cornerstone therapy for DAH due to SLE. Considering this a fatal …

New Onset Bilateral Pleural Effusion: An Uncommon Presentation Of Subclinical Hypothyroidism Or A Premature Closure Diagnosis Error?, Molly Chapman, Andrea Soto Abarca, Duc Khiem Ngo, Carlos T. Ramos

Research Symposium

Background: Subclinical hypothyroidism is biochemically defined with normal serum-free T4 in the presence of an elevated serum TSH. Common symptoms of an underactive thyroid can include fatigue, weakness, cold intolerance, weight gain despite poor appetite, hair loss, constipation, and depression. Pleural effusions have also been recognized as a clinical sequelae in the literature, where up to 25% of patients can develop a pleural fluid collection in the setting of hypothyroidism. Although not well understood, a mechanism includes an increased capillary permeability that leads to the retention of fluid in pleural cavities and other tissues.

Case presenting: A 66-year-old woman …

From Carious To Salivarius: A Case Of Streptococcus Salivarius Infective Endocarditis, Maria E. Torres Perez, Ed Wong Alvarado, Cecilia Salinas Domene, Jennifer Rojas Huen, Sara G. Mojica, C. Garza, Usman Sheriff

Research Symposium

Background: Streptococcus salivarius forms part of the Viridans family which accounts for almost 40% of all endocarditis cases. However, S.salivarius is only attributed to 2% of those cases. In the most common setting, S.salivarius is a commensal bacterium of both the oral mucosa and the gut, but it has proven to have infective potential. S.salivarius accounts as an easily missed and commonly misdiagnosed Viridians strep species, but has been implicated as a rare cause of infective endocarditis.

Case presentation: We present the case of a 43-year-old male who presented with worsening fatigue, chest pain, shortness of breath, and subjective fever. …

Asymptomatic Spontaneous Pneumopericardium In A Young Post-Covid-19 Patient: A Case Report, Jose Gomez Casanovas, Andreina Baird Borja, Eric Sanchez, Alcibiades Fleires, Daniela Hernandez

Research Symposium

Background: Pneumopericardium is a rare clinical condition which is defined as the presence of air or gas in the pericardial cavity. Although uncommon to see, it can present after chest trauma, barotrauma, fistula between the pericardium and surrounding structures, gas producing microorganisms and iatrogenic causes. But spontaneous presentations are even more uncommon. Coronavirus Disease 2019 (COVID 19) infection became a large global epidemic and in addition to respiratory symptoms, involvement of other organs such as pericardium was also reported. We here present a young patient post COVID 19 infection with isolated spontaneous pneumopericardium.

Case Presentation: A 19 year old patient …

A Case Of Recently Diagnosed Uncontrolled Hyperthyroidism Associated With Bilateral Pulmonary Embolism, Jose Gomez Casanovas, Mery Bartl, Lina Pedraza Sanchez, Alcibiades Fleires, Andres Suarez Parraga

Research Symposium

Background: Pulmonary embolism (PE) is a relatively common acute cardiovascular disorder with considerable mortality, despite advances in diagnosis and treatment. In 25 to 50% of first-time cases, no readily identifiable risk factor can be found. Several studies have suggested hyperthyroidism to be a potential hypercoagulable and hypofibrinolytic state. In this case, we present a patient with uncontrolled hyperthyroidism with incidental bilateral PE.

Case Presentation: A 47-year-old Hispanic lady with past medical history of recently diagnosed hyperthyroidism who was not compliant with medical therapy, presented to the emergency department with 4-hour history of chest pain. She described it as sudden onset, …

Transient Sinus Node Dysfunction In A Postpartum Female With Sinus Bradycardia: A Case Report, Jose Gomez Casanovas, Andreina Baird Borja, Laura Rincon-Rueda, Mery Bartl, Daniela Hernandez

Research Symposium

Background: Conduction disorders are common cardiac complications during pregnancy in women with and without structural heart disease. Sinus bradycardia has been described in few case reports secondary to increased vagal tone. Prevalence of newly acquired sinus node dysfunction without structural heart disease is unknown. In this case, we present a post-partum female with symptomatic acquired sinus node dysfunction who presented with severe sinus bradycardia.

Case Presentation: A 32-year-old Hispanic lady with a past medical history of obesity and obstetric formula of G4P4, who recently delivered her 4th child via C-section 4 weeks prior, presented to the Women´s Hospital as a …

Enterococcus Avium Peritonitis, Jian Garcia Cruz, Johanne Chaglasian, Oliverio Abarca Guzman

Research Symposium

Introduction: Enterococcus spp. are part of normal human GI tract flora which has been known to cause community acquired UTI, bacteremia, and nosocomial infections. Enterococcus faecalis and faecium are the most commonly isolated pathogens within enterococcus family although there have been few to no cases reported of peritonitis secondary to enterococcus avium in the setting of recent paracentesis and end-stage-liver disease. The incidence of peritonitis from rare organisms is increasing because of improved microbiological identification techniques. This case is relevant because it shows us that enterococcus avium even if it is not common show be considered when choosing antibiotics coverage …

Syncope As A Presentation Of Waldenstrom Macroglobulinemia, Jian Garcia Cruz, Julio Perez Rodriguez, Roy Subash Kondapavuluru, Eunbee Cho

Research Symposium

Abstract: Syncope as defined by ACC/AHA is defined as a symptom that presents with an abrupt, transient, complete loss of consciousness, associated with inability to maintain postural tone, with rapid and spontaneous recovery without clinical features of other non-syncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness. Syncope is a common complaint treated in the emergency department and a major reason for hospital admissions. Identification of the etiology of syncope is important for diagnostic and therapeutic purposes. Syncope is a symptom as a presentation with multiple differential diagnosis listed and clearly explained …

Grey Turner's Sign Unveiling A Rare Case Of Neuroendocrine Tumor In The Tail Of The Pancreas: A Reminder To Expand The Differential In Young Patients With Chronic Back Pain, Jennifer Rojas Huen, Gilbert Flores Jr., Ismael Pavel Polo Pérez, Nabeel Sarhill

Research Symposium

Background: Pancreatic cancer is often difficult to diagnose due to its asymptomatic nature, silent progression or symptoms overlapping with more common benign conditions. We present a case of a 30-year-old male with chronic worsening back pain, weight loss, and Grey Turner's sign, ultimately leading to the diagnosis of a neuroendocrine tumor in the tail of the pancreas. The rarity of this diagnosis in a young patient with atypical symptoms emphasizes the importance of considering uncommon diagnoses and expanding differentials, even when presented with seemingly typical symptoms, to enable early detection and intervention.

Case Presentation: 30-year-old male past medical history of …

Wait, Wait, Could It Be Autoimmune Pancreatitis? A Case Of Localized Autoimmune Pancreatitis Mimicking Pancreatic Cancer, Grecia Dominguez Rivera, Hari Movva, Heriberto Cantu, Nabeel Sarhill

Research Symposium

Background: Autoimmune pancreatitis (AIP), an IgG4-related disorder, is a rare condition that typically presents as obstructive jaundice and pancreatic enlargement in older adults mimicking the manifestations of pancreatobiliary malignancies. Although the diagnosis of AIP has improved through growing awareness and proposed diagnostic criteria, differentiating between AIP and pancreatic cancer remains challenging.

Case Presentation: A 69-year-old Hispanic male presented with a 1-month history of nausea, epigastric pain, jaundice, and 20-pound weight loss. His medical history revealed type 2 diabetes. Physical exam showed scleral icterus, and laboratory results demonstrated an ALT of 412, AST 404, alkaline phosphate 501, total bilirubin 7.5, direct …

The Great Mimicker. A Case Of Gastrointestinal Tuberculosis., Grecia Dominguez Rivera, Jose Roberto Flores Gonzalez

Research Symposium

Background: Gastrointestinal (GI) tuberculosis (TB) is rare, accounting for 1-3 % of all TB cases worldwide. Mycobacteria enter the GI tract via hematogenous spread from active pulmonary TB, swallowing infected sputum, or ingesting contaminated food. The ileocecal area is most affected; however, tuberculous enteritis can involve any part of the GI tract. The vague clinical presentation makes the diagnosis challenging and often delayed requiring a high index of suspicion.

Case Presentation: A 28-year-old female who emigrated to the US from Mexico presented to the ED with a 4-month history of abdominal pain, vomiting, diarrhea, anorexia, 40-pound weight loss, intermittent fever, …

Spindle-Cell Mesothelioma Arising From The Right Pleura: A Case Report And Review Of The Literature, Duc Khiem Ngo, Karina Torres, Sobia Hassan Memon, Carlos T. Ramos Jr.

Research Symposium

Background: Spindle cell mesothelioma, or Sarcomatoid mesothelioma, is a rare and insidious type of malignant mesothelioma with a high mortality rate. It arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium, and it is usually associated with asbestos exposure. Spindle cell mesothelioma could be challenging to treat because most patients have advanced disease at presentation with an average prognosis of six months. In this case report we present a rare case of spindle-cell mesothelioma arising from the right pleura.

Case presentation: An 82-year-old male with a history of atrial fibrillation and coronary artery disease, status …

Delayed Management Of Pfo After Stroke Presentation In A Healthy Hispanic Female, Diana Othon Martinez, Barbara Malaga-Espinoza, Nestor Gerardo Astorga, Vamsikalayan Borra, Roque Mifuji

Research Symposium

Background: Strokes are a leading cause of long term disability. Around 800,000 people in the USA have a stroke every year. (CDC) 25% of the population have a Patent foramen ovale (PFO). Stroke in the presence of PFO has been described to be found in up to 40% of patients with “embolic stroke of undetermined source”, otherwise known as cryptogenic strokes. Despite the aforementioned prevalence, there is mixed data on PFO management options. Current management guidelines include dual anti-platelet therapy, anticoagulants, and percutaneous transcatheter closure. Some studies suggest that PFO might be an incidental finding in patients with cryptogenic stroke. …

Navigating The Viral Maze: A Twisted Tale Of Ebv-Induced Autoimmune Hemolytic Anemia With Hepatitis, Blesset Alexander, Mery Bartl, Alfarooq Alshaikhli, Michelle Lopez

Research Symposium

Background: Epstein Barr Virus (EBV) is a widely disseminated virus known to cause infectious mononucleosis and a range of associated conditions. Autoimmune hemolytic anemia (AIHA) is a rare complication of EBV infection, with only a small percentage of cases reported in the literature. We present a unique case of a young female patient with a complex autoimmune pattern, later found to be associated with EBV.

Case Presentation: A 22-year-old Hispanic female with no past medical history presented to the Emergency Department with generalized weakness, nausea, left upper quadrant pain, and jaundice progressing for one week. Physical examination revealed scleral icterus, …

Hemophagocytic Syndrome, Radhika Mehta, Bareera Akhtar

Research Symposium

Background: Hemophagocytic syndrome is a rare and potentially fatal disorder characterized by abnormal immune activation leading to multiorgan dysfunction. Although genetic mutation is the most common cause in the pediatric population, adults often present with HPS secondary to infection, autoimmune disease or malignancy. Hodgkin’s lymphoma is a type of lymphoma characterized by Reed Sternberg cells. HL can cause various complications including hemophagocytic syndrome. This is a case of a 22-year-old male with incidental pancytopenia and jaundice, found to have Hodgkin’s lymphoma and hemophagocytic syndrome.

Case Presentation: A 22-year-old male with no significant past medical history presented to the Emergency Department …