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The Fitbit: A novel tool for predicting complete heart block
Firdhous Abdul Kather and Ali Shakir
Bifascicular block has the potential risk of progression to complete heart block. Typically, monitoring for symptoms and heart rate guides timing for definitive pacemaker therapy. Current monitoring devices being used include Holter, event recorder, and implantable loop recorder. We present a case of a 72-year-old male with a history of coronary artery disease coronary artery bypass graft surgery and bifascicular block who presented to the hospital with syncope which... Read More
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Peri-renal and Renal Involvement in Acute Pancreatitis
Yusuf Alalwan, Taha Ashraf, and Rachel Karmally
Introduction: Acute pancreatitis is a common disease characterized by release and activation of proteolytic enzymes which lead to nonspecific inflammation of the pancreas and surrounding tissue. Inflammation can spread to nearby retroperitoneal organs like the kidneys and spleen. Renal involvement can range from acute kidney injury, perirenal fat stranding with perirenal fluid collection to renal vein thrombosis and parenchymal abnormalities. Case Description: 68 years old male with past medical... Read More
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A Rare and Newly Recognized Kaposi Sarcoma Herpes Virus-Associated Disease
Faria Ali, Qunfang Li, Akhil Rahman, Vivek Kak, Michael Somero, Chidamber Alamelumangapuram, and Richard Santos
Introduction: Kaposi sarcoma herpesvirus (KSHV) is associated with Kaposi sarcoma, primary effusion lymphoma and multicentric Castleman disease (KSHV-MCD) in patients infected with human immunodeficiency virus (HIV). We present a case consistent with a newly recognized KSHV inflammatory cytokine syndrome (KICS), distinct from KSHV-MCD. Case Report: A 33-year-old African American male with a prior history of syphilis, HIV/AIDS on Triumeq and stage IV Kaposi sarcoma on Doxorubicin, presented with worsening... Read More
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CADASIL subcortical dementia – A case report
Ahmad Aljamal
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, or CADASIL, is a genetic disease that eventually results in early-onset strokes and dementia. It is one of the most common hereditary causes of strokes and vascular dementia. The mutation involves the NOTCH3 gene, a gene implicated in small vessel proliferation and remodeling. Interestingly, the majority of the small vessel pathology occurs in the vasculature of the subcortical regions of... Read More
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Paradoxical Coronary Embolus-A Rare Cause of ST-Elevation Myocardial Infarction
Hussayn Alrayes and Sachin Parikh
Introduction: Paradoxical emboli are well-described causes of peripheral arterial occlusions and stroke but can be involved in coronary vasculature in up to 10% of cases. Given the rarity and potentially devastating effects, high suspicion for this entity is paramount in individuals with low risk for atherosclerotic disease who present with coronary occlusion. Our case demonstrates a patient who was initially diagnosed with bilateral pulmonary embolisms (PE), but upon further... Read More
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Metabolic Alkalosis in Pregnant Patient Due to Citrate Load with Plasma Exchange
Maria Andrievskaya, Daniel Peisach, Chandrika Chitturi, Junior Uduman, Jian Li, Ilena Lopez, and Sandeep Soman
INTRODUCTION: Sodium citrate has been widely utilized as an anticoagulant in plasmapheresis (PP). Metabolic alkalosis is a well known complication of PP in patients with impaired ability to excrete byproducts of citrate metabolism. We report a rare case of iatrogenic citrate toxicity leading to profound metabolic alkalosis in a pregnant patient. METHODS: A 22-year-old pregnant female, gestational age 16 weeks, was admitted with fever, rash and myalgias. She was... Read More
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Acquired Acrodermatitis Enteropathica Secondary to Nutritional Deficiency from Alcoholism
Harleen Arora, Allison Zarbo, Aditya Kotecha, and Holly Kerr
History A 30-year-old white male with history of alcoholism complicated by cirrhosis who presented to an outside hospital with loss of consciousness after being found down in excrement and urine for an unknown amount of time. Patient’s course was complicated by pancreatitis, urosepsis, spontaneous bacterial peritonitis, and hepatic encephalopathy. Patient was transferred to Henry Ford Hospital for further management, and dermatology was consulted for a one-year history of pruritic... Read More
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Rapidly Progressive Statin Induced Necrotizing Myopathy
Taha Ashraf, Yusuf Alalwan, and Eric Scher
Statins are common lipid lowering agents used worldwide to reduce cardiovascular mortality. Statin induced myopathies vary widely in severity extending from myalgia’s to life threatening rhabdomyolysis or necrotizing autoimmune myopathy.Here we present a case of a 50 year old male with coronary artery disease and alcoholic liver cirrhosis with multiple recent admissions for spontaneous bacterial peritonitis. He was admitted to our institution from a subacute rehabilitation facility for symptomatic... Read More
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Urgent Surgical Embolectomy for Retinal Embolus
Andre Aung and Daniel Brill
Purpose: Branch retinal artery occlusions can lead to devastating, permanent vision loss. Here we present a case of branch retinal artery occlusion (BRAO) treated with surgical embolectomy.Methods: A 67 year-old female presented with 14 hours of vision loss in the left eye. She had an ocular history of bilateral pseudophakia and bilateral pars plana vitrectomies (PPVs) for epiretinal membrane removal. Her medical history was notable for diabetes mellitus, hypertension,... Read More
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Discoid Lupus Erythematosus with Hydroxychloroquine-Induced Hyperpigmentation
Olabola Awosika
HISTORY: A 65-year-old African American female presented for follow-up of an 8-year history of biopsy proven discoid lupus erythematosus (DLE) of the bilateral upper eyelids. She had significant re-pigmentation of the eyelids on hydroxychloroquine 200 mg once daily, tacrolimus 0.1% ointment several times a week as needed, and daily SPF 50 sunscreen use. However, over the last few years, she noted asymptomatic, increased darkening of the skin on her... Read More
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When The Horse Becomes the Zebra: Malignant Transformation of a Teratoma
Ryan Beckett
Background: Ovarian germ cell tumors (OGCT) represent between 1 in 5 and 1 in 4 ovarian neoplasms but are overwhelmingly benign with only a 5% malignancy rate. Within this category, mature teratomas (also known as ovarian dermoid cysts) are the most common type. And while they in fact represent the most common ovarian neoplasm in women age 30-40, they can occur at any age. The tumor is defined by... Read More
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Rewarming Severe Hypothermia Using Esophageal Temperature Management Device
Andrew Bissonette, Joseph B. Miller MD, and Jacqueline Pflaum-Carlson
Objectives: External rewarming often fails to correct the temperature of patients with severe hypothermia. In these cases, various invasive techniques have classically been utilized, including intubation with heated ventilation, heated peritoneal dialysis, thoracic lavage, gastric or colonic lavage, mediastinal irrigation (in arrest), central venous temperature management catheters, and extracorporeal rewarming. All of the invasive procedures above are associated with various procedural complications, and most of the vascular interventions above... Read More
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Infliximab-Induced Arthralgia
Allan Brazier, Guneet Ahluwalia, Tushar Shetty, and Alexis Haftka-George
Case Presentation: A 23-year-old Caucasian female with a history of ulcerative colitis (UC) presented with erythematous, painful metacarpal joints and jaw pain; she had associated symptoms of fatigue, chills, and dyspnea. Additional history included Crohn’s disease status post-proctocolectomy, primary sclerosing cholangitis, and hypothyroidism. Physical exam showed a fatigued female with bilateral metacarpal joint arthralgias and erythema along with shoulder weakness. She was diagnosed with UC 2 years prior and... Read More
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A Woman with Hyperpigmented Plaques of the Face
Stephanie Chapman, Jesse Veenstra, and Henry W. Lim
History: A 56-year-old African American female presented for evaluation of a 10-year history of dark patches involving the forehead, malar cheeks, nose, ears, upper back, and extremities. She endorsed daily pruritus of the ears, face, and back that was accompanied by an intermittent burning sensation. Prior treatment with hydroxychloroquine, topical, intralesional and systemic corticosteroids was of little benefit. Exam: On the face, in a photo-distributed pattern, there were hyperpigmented... Read More
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Primary Effusion Lymphoma in an HIV negative male with history of Kaposi Sarcoma
Saad Chaudhry, Lovepreet Singh, Shannon Wills, and Omokayode Osobamiro
Background: Primary effusion lymphoma, a subtype of Non-Hodgkin’s lymphoma, is linked with HHV-8. This disease is associated with immunocompromised patients such as those who have HIV, solid organ transplant carriers, or chronic hepatitis C. Primary effusion lymphoma frequently commences in the pleura, pericardium, and peritoneum. Case: A 77 year old middle eastern male with history of tobacco usage was admitted for fatigue and hypotension. Chest x-ray revealed bilateral pleural... Read More
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Skin and Soft tissue infections - The New Kid on the Block
Zohra Chaudhry
Introduction: Rapidly growing mycobacterium (RGM) skin and soft tissue infections are increasing in incidence. These infections can be challenging to treat and require multiple antibiotics for prolonged duration.This is a rare case of an immunocompetent male with Mycobacterium Septicum wound infection.Case presentation:52-year-old male with known history of hypertension and end-stage renal disease, was referred to Infectious disease (ID) clinic for multiple skin lesions.Initially noticed lesions near his right elbow... Read More
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Inadvertent Intrathecal Injection of Ionic Contrast – Seeing is Believing!
Gaurav Chauhan, Aman Upadhyay, Mun Choe, and Joseph Salama Hanna
We present a case report of a 47-year-old man who was scheduled for Lumbar epidural steroid injection for Lumbosacral radiculopathy under flouroscopy. During the procedure there was inadvertant injection of Gadavist dye in the intrathecal space. The procedure was subsequently aborted. The patient developed agitation and latered sensorium inthe pain clinic. He was immmediately tranferred to the ER, where he was intubated. A non-contrast computerized tomography scan of head,... Read More
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Tuberculous Peritonitis: An Unusual Diagnosis For Vague Abdominal Pain
Zachary Ciochetto and Michel Hanna
Mycobacterium Tuberculosis (MTB) continues to affect millions of people worldwide and remains a significant cause of mortality in those who contract the disease and do not receive proper treatment. This phenomena also explains why this disease continues to be transmitted when they are not properly isolated. Predominantly the focus is on pulmonary TB but that is only one of many complications of the disease. Miliary TB occurs when the... Read More
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