The Medicine Forum

http://jdc.jefferson.edu/tmf

List of Papers (Total 402)

Resident Reflection: A Missed Date

Resident Reflection: A Missed Date

Roth Spots in Bacterial Endocarditis

CASE PRESENTATION A 30-year-old female with a history of intravenous drug use presented to the hospital with left wrist pain. Physical exam revealed a left volar ulnar wrist abscess with purulent drainage, a holosystolic murmur heard best at the apex radiating to the axilla and Janeway lesions on the right hand and bilateral feet. A transthoracic echocardiogram revealed a 20 mm...

Massive Pneumoperitoneum

CASE PRESENTATION A 72-year-old man with a past medical history of pancreatic adenocarcinoma status post biliary and duodenal stent placement presented to the emergency department for one week of cramping abdominal pain in the setting of a surveillance abdominal/pelvis computed tomography (CT) scan done two days prior to admission that showed massive pneumoperitoneum (Figure 1...

Clinical Image: Halo Sign

CASE PRESENTATION A 68-year-old man with no significant past medical history was transferred to our hospital for evaluation of newly diagnosed acute leukemia. His bone marrow biopsy showed acute undifferentiated leukemia. He was initiated on standard induction chemotherapy with cytarabine and idarubicin. His hospital course was complicated by neutropenic fever secondary to...

Amyotrophic Lateral Sclerosis Presenting as Chronic Cough

INTRODUCTION Amyotrophic Lateral Sclerosis (ALS) is a debilitating, uniformly fatal disease. While it most commonly presents with limb weakness, patients may also present with neurocognitive, respiratory, or bulbar symptoms. Despite its poor prognosis, an early diagnosis can save patients from unnecessary and expensive testing, lead to interventions that improve quality of life...

A Case of Cryptogenic Organizing Pneumonia Managed without a Diagnostic Biopsy

INTRODUCTION Organizing pneumonia (OP) is a type of diffuse interstitial lung disease characterized by a specific histopathologic pattern of response to lung injury. When the etiology of the injury is unknown and in the absence of inflammatory or connective tissue disease, this entity is termed cryptogenic organizing pneumonia (COP) or primary organizing pneumonia (POP). Disease...

Fifty Shades of Sarcoidosis: A Case Report of Löfgren Syndrome

INTRODUCTION Sarcoidosis is a multi-organ disorder that is characterized by the presence of noncaseating granulomas in involved organs. It commonly affects young and middle-aged individuals of all races, but is 3-4 times more common in African Americans and typically presents earlier with more severe symptoms.1 The lungs are affected in 90% of patients and pulmonary disease...

Use of Venovenous Extracorporeal Membranous Oxygenation Following Iatrogenic Tracheal Rupture

INTRODUCTION Iatrogenic tracheal rupture is a rare complication of endotracheal intubation and has a high risk of morbidity and mortality. Risk factors include female gender, short stature (height less than 160-cm), difficult airway anatomy, underlying connective tissue disorder, chronic obstructive pulmonary disease, use of a rigid stylet, inadequate intubation tube size, cuff...

A Case of Eosinophilic Granulomatosis with Polyangiitis

INTRODUCTION Eosinophilic granulomatosis with polyangiitis (eGPA) is a small- and medium-sized-vessel vasculitis with multi-organ manifestations. Given the rarity of eGPA, patients are often misdiagnosed for decades and may initially present with life-threatening manifestations of late-stage disease. Therefore, it is important to raise awareness of this condition and its...

Tenofovir Cons the Kidneys: A Case of Acquired Fanconi

INTRODUCTION Proximal (Type 2) renal tubular acidosis (RTA) is a relatively rare diagnosis, especially in adults. It is characterized by a reduction in proximal bicarbonate reabsorption resulting in urinary bicarbonate wasting. Proximal RTA can also be associated with additional defects in proximal tubular function including impaired reabsorption of phosphate, glucose, uric acid...

Resistant Raoultella Ornithinolytica Bacteremia in a Patient with New Acute Myeloid Leukemia

INTRODUCTION Members of the Raoultella genus were formerly considered to be Klebsiella species until they were differentiated based on phylogenetic Deoxyribonucleic acid (DNA) analysis.1 Since then, Raoultella ornithinolytica has been sparsely implicated in clinically-apparent disease, though more case reports are appearing as of late. Here we report the first documented instance...

A Case of Secondary Hemophagocytic Lymphohistiocytosis in an Adult Patient Treated with Concurrent Dexamethasone and Interleukin-1 Receptor Blockade

INTRODUCTION Hemophagocytic Lymphohistiocytosis (HLH) is a rare, life-threatening syndrome of overwhelming inflammation caused by activation and proliferation of T-lymphocytes and hemophagocytic macrophages. This uncontrolled proliferation of macrophages creates a cytokine storm with resultant tissue damage. HLH is associated with clinical and laboratory findings which include...

Death by Delirium: A 71-Year-Old Male with Poor Post-operative Recovery

INTRODUCTION Delirium is an acute decline in attention and cognition not better explained by another medical condition.1 It is multifactorial in origin, with risk factors including advanced age, male sex, baseline decreased cognitive status, sensory impairment, poor baseline functional status, polypharmacy, and multiple comorbid conditions. Acute precipitants for delirium include...

When DeQuervain’s DePigments: A Case of Iatrogenic Hypopigmentation

INTRODUCTION Localized joint and soft tissue corticosteroid injections are being increasingly utilized to decrease inflammation, improve pain, and recover mobility. Adverse effects from injections are rare, with a 1% incidence of skin depigmentation.

Maggots—Friend or Foe? Treating Myiasis in a Patient with Chronic Wounds

INTRODUCTION Myiasis, or the infestation of living vertebrates with dipterous (two-winged fly) larvae, can take many forms. Depending on their species, maggots will feed on living or dead tissue, liquid body substances, or even ingested food.1 The anatomical classification system of such larvae is based on the host location of infestation: sanguinivorous, cavitary, or cutaneous...

Liver Abscess Turned Metastatic Infection in an Otherwise Healthy Patient: A Case Report

INTRODUCTION The most common type of visceral abscesses are liver abscesses, which have a mortality rate of at least 2.5 percent.1,2 Most liver abscesses are polymicrobial, containing both facultative and anaerobic enteric pathogens, and develop secondary to another infection such as peritonitis and cholangitis, or from hematogenous spread.2-4 Liver abscesses are sometimes...

Octreotide-Induced Hypoglycemia in a Cirrhotic Patient

INTRODUCTION Hepatorenal syndrome (HRS) is characterized by functional renal impairment in patients with end-stage liver cirrhosis and no parenchymal kidney disease. It is due to splanchnic vasodilation, which results in renal vasoconstriction with consequent reduction in renal plasma flow and glomerular filtration rate.1 In the United States, treatment is with a combination of...

Case Report: Coexistence of Papillary Thyroid Cancer and Thyroid Lymphoma

We describe a case of a 75-year-old female found to have concurrent papillary thyroid cancer and diffuse large B cell lymphoma of the thyroid.

Cat Scratching Your Valve: An Elusive Case of Bartonella Endocarditis

INTRODUCTION Bartonella Henselae is an uncommon, but significant cause of “culture-negative” endocarditis. While six Bartonella species have reportedly caused infective endocarditis (IE) in humans, the vast majority of cases are secondary to either B. quintana or B. henselae. The epidemiologic features of patients predisposed to Bartonella endocarditis are varied. Alcoholism...

Acute Aortic and Mitral Valve Insufficiency Precipitated by Infective Endocarditis

INTRODUCTION Acute severe valvular regurgitation is a medical emergency requiring prompt recognition and diagnosis. Both mitral and aortic valve rupture, if left untreated, inevitably lead to advanced heart failure, cardiovascular collapse, and death. As such, rapid diagnosis is critical and surgical valve repair or replacement is a life-saving intervention. We present a case of...

The Opioid Epidemic – Addressing Provider Roles and Responsibilities

INTRODUCTION This year marks the 19th volume of Jefferson’s annual publication spearheaded by Internal Medicine residents and supported by its fellows. Our Editorial Board includes Neha, Debbie, Anita, Brianna, and myself. Our mission is to further medical knowledge by sharing each other’s observations and studies both through our publication, which you can find online, as well...

White Paper: Improving Handoff Culture in Intensive Care Unit to Floor Handoffs

The frequency of handoffs between providers has increased since the 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions, generating concerns over the quality of these handoffs and their impact on patient safety. At Thomas Jefferson University Hospital (TJUH), the 2016 Safety Culture Survey revealed that across all specialties, many residents...