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Journal of Community Hospital Internal Medicine Perspectives

Mustafa Dawood, Abubakar Tauseef, Janki Patel
CMV can infect a variety of organs including gastrointestinal tract, meninges, eyes and other organs depending upon the nature of immune system but it can also manifest as a flare-up in ulcerative colitis patients. It usually presents as loose stools, bright red blood in the stool and weight loss in the patient. In the setting of an Immunocompetent patient, CMV colitis has been diagnosed in patients with occult inflammatory bowel disease. It is usually diagnosed on histology secondary to endoscopic biopsy. We herein report a case of a 73 years old female with CMV colitis found to have underlying ulcerative colitis...
2018: Journal of Community Hospital Internal Medicine Perspectives
Irfan Shaukat, Amrit Pudal, Sayf Yassin, Naseruddin Höti, Sadaf Mustafa
Fetal Hemoglobin (HbF, α2γ2) is produced from the eighth week of gestation, constitutes 60 - 80 % of total hemoglobin by birth, which is then replaced with adult Hemoglobin A1 (HbA1: α2β2) by 6-12 months. Hereditary Persistence of Fetal Hemoglobin (HPFH) is a rare benign asymptomatic genetic disorder where the HbF persists, and incidentally discovered on screening for other hemoglobinopathies. In adults, the variation in HbF levels could also be associated with other disease states, including hemoglobinopathies, leukemias and bone marrow failure syndromes...
2018: Journal of Community Hospital Internal Medicine Perspectives
Antony Lixon, Ebad Ur Rahman, Chitra Annie Mohan, Bikas Bhattarai, Frances Schmidt
Heparin Induced thrombocytopenia (HIT) is a rare, immune-mediated complication of heparin, associated with both thrombocytopenia and paradoxical thrombotic events. Initial diagnosis is made clinically when platelet count falls by 30% to <100 × 109 cells/l or a > 50% decrease from baseline count in association with heparin therapy. Thromboembolic complications are seen in 50% of the cases. We present a case of acute pulmonary embolism (aPE) in a 65 year old male secondary to HIT while on unfractionated heparin for venous thromboprophylaxis...
2018: Journal of Community Hospital Internal Medicine Perspectives
Divya Akshintala, Anjeanette Mendez, Ossama I Ikladios, Vamsi Krishna Emani
Aspirin remains one of the most common agents involved in both accidental and intentional overdose. The availability of enhanced elimination and early hemodialysis has been known to reduce the number of deaths from salicylate poisoning. We present the case of an intentional aspirin overdose with enteric-coated preparation that had continuously rising salicylate levels despite treatment with bicarbonate drip, continuous dialysis and activated charcoal.
2018: Journal of Community Hospital Internal Medicine Perspectives
Beenish Fayyaz
Discovered by Louis Pasteur in 1880, Pasteurella multocida is the most common cause of zoonotic infection in humans which is transmitted via pet bites and/or scratches. However, animal contact may be absent or not identified in up to 40% of cases which usually occur in individuals with comorbidities. Despite having a low virulence, PM can cause serious and life threatening infections in rare instances. In such cases, prompt diagnosis and appropriate treatment can lead to miraculous recovery.
2018: Journal of Community Hospital Internal Medicine Perspectives
Syed Raza Shah, Terance Millan, Sardar Muhammad Alamzaib, Sue-Wei Luu
Thyroid storm, defined as an endocrine emergency in 1926, remains a challenge for physicians in the 21st century. The mortality rate of untreated thyroid storm is very high. Hence, if a thyroid storm is suspected, treatment should not be delayed. This disease can be fatal! We present the case of a 86-year-old female presenting with altered mental status. All the tests came out negative except for elevated free t4 (ft4) with a very low TSH level (ft4-7.87, TSH< 0.005). Patient was diagnosed with thyroid storm in the setting of subclinical hypothyroidism and improved significantly with treatment...
2018: Journal of Community Hospital Internal Medicine Perspectives
Ateeq Mubarik, Syed Moin Hassan, Monicka Felix, Salman Muddassir, Furqan Haq
Introduction: Sarcoidosis is an inflammatory granulomatous multisystem disease with an unknown etiology. Neurosarcoidosis is a cryptogenic neuroinflammatory manifestation of sarcoidosis. Case report: We describe a case of neurosarcoidosis with initial presentation as confusion. Our patient fits the picture of probable neurosarcoidosis as per the Zajicek et al criteria, with the clinical presentation of neurosarcoidosis, evidence of inflammation in the CNS, evidence of systemic sarcoidosis and exclusion of other diseases...
2018: Journal of Community Hospital Internal Medicine Perspectives
Christopher Mercogliano, Muhammad Khan, Catherine Lin, Elan Mohanty, Ryan Zimmerman
Acute Generalized Exanthematous Pustulosis (AGEP) is a rare drug reaction manifesting as pustular lesions with surrounding erythema following exposure. The disease is often self-limited and treatment is supportive. It may present in an atypical variant with vesicles that desquamate into erosions, which classifies the disease as an AGEP/SJS Overlap. This overlap syndrome can carry a substantial mortality rate and necessitate elevation in the level of care. Hydroxychloroquine has been implicated in cases of AGEP, and we present a case of AGEP/SJS overlap attributed to this common medication...
2018: Journal of Community Hospital Internal Medicine Perspectives
Syed Raza Shah, Najla Issa Najim, Syed Arbab Shah, Waqas Shahnawaz, Muhammad Ahmed Jangda
Advanced Heart Failure (AHF) is a complex syndrome that affects the physiology of the heart to maintain efficient blood circulation resulting in multiorgan failure and, eventually, death. Left Ventricular Assist Devices (LVADs) have become the cornerstone therapy for AHF patients, both as a bridge to transplantation and as a decisive therapy. Recently the results of the MOMENTUM 3 Trial were published. The trial compared HeartMate 3 LVAD with HeartMate II LVAD in a randomized trial in The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3)...
2018: Journal of Community Hospital Internal Medicine Perspectives
Mahmoud Barbarawi, Ahmed Aburahma, Yazan Zayed, Mohammed Osman, Laith Rashdan, Bakr Swaid, Ghassan Bachuwa
Background : Diabetes is a very common cause of cardiovascular disease, and metformin remains the first-line treatment of diabetes. Many trials were conducted to prove the efficacy and safety of other antidiabetic medication as the best add-on medication. Objectives: We aimed to evaluate the atherosclerotic effect of incretin mimetics in patients with diabetes. Methods : We searched in PubMed, and Cochrane Library for randomized controlled trials (RCTs) comparing incretin mimetic with conventional treatment...
2018: Journal of Community Hospital Internal Medicine Perspectives
Moni Roy, Sharjeel Ahmad, Ashish Kumar Roy
Tuberculosis of the central nervous system (CNS-TB) is a critical disease with poor prognosis if not diagnosed and treated early. A regimen of drugs with good CNS penetration is required for treatment. Treatment options are limited in case of hypersensitivity reaction of the recommended regimen. We are reporting a rare instance where a patient developed hypersensitivity to both first line agents (isoniazid and rifampin) for CNS-TB and was successfully desensitized against both these medications to complete the treatment course using the rapid desensitization process...
2018: Journal of Community Hospital Internal Medicine Perspectives
Qiuyu Jin, Sam Kant, Jihad Alhariri, Duvuru Geetha
Levamisole is an antihelminth drug and a common cocaine contaminant, present in an estimated 71% of cocaine samples in the US. Levamisole-contaminated cocaine has been linked to an ANCA-associated vasculitis with cutaneous, renal, and pulmonary manifestations. We report the case of a 46 year old woman with known cocaine exposure who presents with recurrent, large purpuric and maculopapular rash of the extremities and face and review existing cases of levamisole/cocaine-associated ANCA vasculitis, We summarize the clinical presentation, treatment, and outcomes of levamisole induced vasculitis...
2018: Journal of Community Hospital Internal Medicine Perspectives
Omar Abdulfattah, Ebad Ur Rahman, Fnu Shweta, Praveen Datar, Zainab Alnafoosi, David Trauber, Mirela Sam, Danilo Enriquez, Frances Schmidt
Background: Nontuberculous mycobacterium is a recognized cause of hypercalcemia, particularly in patients with acquired immunodeficiency syndrome (AIDS). Here we describe a case of severe hypercalcemia secondary to Mycobacterium abscessus ( M. abscessus ) in a patient with AIDS. To the best of our knowledge this is the first case report describing a case of M. abscessus presenting as retroperitoneal lymphadenopathy and severe hypercalcemia. Case description : A 56-year-old man with AIDS presented with altered mental status and somnolence for four days...
2018: Journal of Community Hospital Internal Medicine Perspectives
Khaled Mohammed Al Amry, Maha Al Farrah, Saeed Ur Rahman, Imad Abdulmajeed
Background : Since the time of Hippocrates, dress of the care-giver has been known to influence patient's perception about the physician. Objectives: To explore patient's preference about physician's dress in Saudi primary healthcare, and how it influences their perception, regarding professionalism, competence, and confidence in the physician. Methods: A cross sectional study conducted in primary care clinics in Riyadh, enrolling 443 patients, who filled a self-administered Arabic questionnaire, enquiring about physician clothes such as white coat, scrubs and 'thob (white-robe) shomagh (head cover)' for males, 'veil-skirt' for females, and shoes...
2018: Journal of Community Hospital Internal Medicine Perspectives
Nicole Roe, Michael Wang, Samuel J Wisniewski, Richard Douce
Objective : The objective of this study was to review the impact of an automatic email notification to infectious disease consultants. Design : Cases were identified from a community hospital system microbiology database by at least one positive blood culture. Records were reviewed both before (2013 and 2014) and after (2015 and 2016) the implementation of the automated email system (intervention). Prior to this policy, consultation with the infectious disease (ID) specialist was at the discretion of the primary team...
2018: Journal of Community Hospital Internal Medicine Perspectives
Youssef Soliman, Megan Soliman, Qamar Ahmad, Laura vonDoenhoff
Stress cardiomyopathy or Takotsubo cardiomyopathy (TCM) is transient left ventricular apical akinesis in the absence of angiographic evidence of corresponding obstructive coronary artery disease. A classic presentation is of chest pain following intense emotional or physical stress. Reports of stress-inducing triggers include acute respiratory failure, sudden death of a loved one, sympathomimetic drugs, pheochromocytoma crisis, diabetic ketoacidosis, and even earthquakes. We report three cases of intra-abdominal etiologies precipitating Takotsubo cardiomyopathy: two with small bowel obstruction, and one with Clostridium difficile colitis...
2018: Journal of Community Hospital Internal Medicine Perspectives
Dariush Shahsavari, Bryan Zoll
Hyperthyroidism is associated with increased risk of cardiovascular conditions. We report a case of a 50-year-old woman with no prior cardiac history who presented to the emergency department with shortness of breath, chest pain, lower extremity swelling, and generalized fatigue. She was found to have Graves' Disease (GD) and extensive coronary artery disease (CAD), suggesting the possibility of increased risk of de novo CAD in patients with GD in the absence of other risk factors.
2018: Journal of Community Hospital Internal Medicine Perspectives
Corbin Pagano, Ana Cios, Stefan David
Cutaneous angiosarcoma (CA) is a rare form of cancer with limited treatment options and has a very severe prognosis. In this case report, a differential diagnosis, ranging from infection and neoplasia to autoimmune disease, was attributed to recurrent cellulitis centered on a purple lesion. The continuous pursuit of a diagnosis and treatment plan had to be tailored in accordance with patient goals of care. Careful anticipation of disease progression and complications was required following the diagnosis of CA and involved careful transition from palliation to hospice care...
2018: Journal of Community Hospital Internal Medicine Perspectives
Omar Abdulfattah, Ebad Ur Rahman, Zainab Alnafoosi, Frances Schmidt
Introduction : Unhealthy use of alcohol can be associated with serious adverse events. Patients with alcoholism and malnutrition are at high risk for electrolyte disturbances, commonly hypokalemia. Here in we describe a case of alcohol use disorder presented with weakness and subsequently developed cardiac arrest secondary to severe hypokalemia. Case description : A 51-year-old lady presented to our emergency department because of generalized body ache and marked weakness in both lower extremities for two days duration...
2018: Journal of Community Hospital Internal Medicine Perspectives
Stephen Melnick, Priya Rajagopalan, Theresa Lynn, Anthony Donato
Context : Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are a novel treatment approved for type 2 diabetes mellitus to lower hyperglycemia, systolic blood pressure, and promote weight loss. Commonly reported serious adverse events include increased mycotic urogenital infections, orthostatic hypotension, and normoglycemic ketoacidosis. Case report : We present a case of a 47-year old man with a history of type 2 diabetes mellitus initiated on the SGLT-2 inhibitor canagliflozin preoperatively before a penile implant, who presented with late postoperative MRSA bacteremia and scrotal abscess requiring implant extraction...
2018: Journal of Community Hospital Internal Medicine Perspectives
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