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Risperidone-Induced ITP
Amira Al-Nabolsi, Vraj Tripathi, George Darany, and Omar Khan
Publication Date: 5-9-2024
Immune Thrombocytopenia Purpura is a hematologic condition characterized by a selective decrease in platelet count.
White blood cell and hemoglobin levels remain within normal limits.
Clinical manifestation includes widespread purpuric rash and mucocutaneous bleeding.
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More Than You Can Swallow: Mycotic Aneurysm, An Uncommon Etiology of Dyspepsia
Hussein Bazzy, Katharine Glover, Steven Jones, James Aldridge, Michael Potes, and Katie Sumnicht
Publication Date: 5-9-2024
Dyspepsia is defined as predominant epigastric pain lasting greater than one month.
Common etiologies of dyspepsia include peptic ulcer disease, medications, and gastroesophageal reflux.
We present a rare case of dyspepsia caused by a mycotic aneurysm due to accidental foreign body ingestion leading to emergent inpatient intervention.
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Atypical Presentation of Legionnaires' Disease
Hassan Eidy, Barbara Senger, Joshua Steele, and Jolian Kathawa
Publication Date: 5-9-2024
Legionnaires’ disease or Legionellosis is a subtype of pneumonia caused by the gram negative bacilli, Legionella pneumophila.
L. pneumophila serogroup 1 accounts for 50-80% of Legionnaires’ disease. ▪ Patients commonly present with fevers, chills, myalgia, cough and less commonly with confusion, nausea, vomiting, diarrhea, and/or anorexia.
Treatment primarily consists of antibiotics with supportive measures. ▪ Renal and hepatic extrapulmonary manifestations from Legionella are rare, and often present with multisystem involvement when they do occur.
This case highlights a unique, and rare, presentation of Legionnaires’ disease mimicking alcoholic hepatitis with 2:1 AST/ALT transaminitis and physical exam findings.
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A Bizarre Halloween: A Rare Etiology of Phytobezoar
Catharine R. Glover, James Aldridge, and Tedd March
Publication Date: 5-9-2024
A phytobezoar is defined as the composition of indigestible food particles found in the GI tract, primarily composed of plant material, such as fibers and cellulose.
Any individual may develop a phytobezoar, but those with altered gastrointestinal anatomy or decreased motility are at highest risk.
They often present with nausea, vomiting, and/or symptoms of gastric outlet syndrome.
Complications include ulcerations, bleeding, bowel obstruction, and/or perforation.
Thus, complete removal is the ultimate treatment.
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Purr-Ils of the Liver: A Case of Mash Cirrhosis Complicated by Disseminated Pasteurella
Joanna Henry, Alaa Abujame, Cameron Hubbard, Angela Shermetaro, James Hebden, Hussein Bazzy, Jared Grodman, Katie Sumnicht, and Christopher Cooley Cooley
Publication Date: 5-9-2024
Pasteurella Multicoda is a gram-negative coccobacillus that is commensal to mammals such as domesticated pets and transmitted to humans by scratches or bites. The extent of infection is often limited to soft tissue, bone, and joint.
Disseminated infection by P. multicoda infrequently is typically associated with peritoneal dialysis.
We present a case of disseminated P. multocida infection with bacteremia and peritonitis in a patient with NASH Cirrhosis.
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Anti-Yo Positive Paraneoplastic Cerebellar Degeneration: A Case of Discovering Fallopian Tube Cancer From Neurological Symptoms
Sydney Jacobs, Alaina Skotak, and Inna Sta Maria
Publication Date: 5-9-2024
Paraneoplastic syndromes are rare neurological disorders associated with cancer at distant tumor sites. Prevalence is ~1-3% of all cancers, with an estimated 17,099 cases in the US in 2021.
Paraneoplastic cerebellar degeneration (PCD) is one subtype, primarily associated with gynecological and breast cancer, especially in women older than 60.2
Can cause significant functional impairment (e.g. abrupt onset truncal ataxia, room-spinning dizziness, dysarthria, and diplopia).
Neurological symptoms often precede cancer diagnosis.
Pathophysiology of PCD: Tumor-induced autoimmunity against cerebellar antigens.4 About 30 types of antibodies, one being anti-Yo antibody (or Purkinje cell cytoplasmic antibody type 1, (PCA-1)) acting on human cerebellar degeneration-related protein.
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Readmission Rates In Complex Cases Does Review of AVS with Patients/Families Lead to Lower Readmissions?
Nick Leventis
Publication Date: 5-9-2024
Does review of discharge plans with patients in complex cases truly have a benefit? The primary objective of this quality improvement project was to investigate if reviewing after visit summaries (AVS) with patients/families in complex cases leads to lower readmission rates compared to discharges where this was not performed.
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Takotsubo Cardiomyopathy Resulting in Hypoxic Hepatitis
Jamil Qarqash, Devon Pyykkonen, and Olga Brushaber
Publication Date: 5-9-2024
Elevated liver enzymes are frequently observed in hospital settings, requiring a high level of suspicion for shock liver. In this report, we present a rare case of shock liver induced by Takotsubo cardiomyopathy (TCM). After other common causes of aminotransferase levels exceeding 1000 U/L were excluded, the focus shifted to managing the patient’s hemodynamics. This approach resulted in significant improvement of transaminase levels back to normal.
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A Rare Case of Radial Arteriovenous Formation After Transradial Cardiac Catheterization
Barbara Senger, Hassan Eidy, Andrew Gray, and Robert Grodman
Publication Date: 5-2024
In the United States, more than one million cardiac catheterization procedures are performed each year for diagnostic and therapeutic purposes.
Right heart catheterizations allow for direct measurement of right-sided cardiac and pulmonary hemodynamics while left heart catheterizations provide a diagnostic and therapeutic role in those with coronary artery disease.
In 1989, Lucien Campeau proposed the use of a smaller caliber catheter to access the small radial artery as a way to reduce the rates of bleeding complications.
Advantages of utilizing the transradial artery (TRA) approach over the transfemoral artery (TFA) approach include:
– Improved patient quality-of life metrics.
– Reduced major bleeding and access site complications.
– Lower total hospital costs.
Access-site complications including radial artery occlusion and arteriovenous fistula (AVF) formation from TRA are rare and usually of minimal clinical impact.
AVF may present with pain and edema at the puncture site, a pulsatile thrill, and/or visible dilated superficial veins.
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Mounjaro Mediated Drug-Induced Immune Thrombocytopenia
Barbara Senger, Zachary Howarth, Ali Baydoun, and Benjamin Rossi
Publication Date: 5-9-2024
Thrombocytopenia is a condition in which a person has low platelets or thrombocytes in the blood.
Symptoms of thrombocytopenia vary based on severity.
Mild: asymptomatic.
Moderate: prolonged bleeding following trauma, easy ecchymosis, petechiae and purpura.
Severe: spontaneous ecchymosis/petechiae/purpura, spontaneous mucosal bleeding, life threatening internal bleeding.
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Liver Injury, Renal Failure, and Pancytopenia after Radioactive Iodine Treatment for Papillary Thyroid Carcinoma: A Case Report
Angela Shermetaro, Grant Hupp, and Jordan Bushman
Publication Date: 5-9-2024
Radioactive Iodine (RAI) has been used for diagnosis and treatment of thyroid carcinomas since the 1940’s. Some known side effects include gastritis, radiation thyroiditis, and bone marrow suppression. However, there are minimal reports on radioactive iodine causing drug induced liver injury (DILI) and renal failure.
To our knowledge, this is the first reported case of both hepatic injury and renal failure following RAI treatment.
We describe an 83-year-old female who developed DILI and renal failure after radioactive iodine ablation.
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Subacute Combined Degeneration of the Spinal Cord Induced by Nitrous Oxide Abuse: A Rare Patient Presentation to a Spine Surgery Clinic
Jacob Shermetaro, Michael Bridges, Jonathan Avon, Nilesh Patel, and Brian Vosko
Publication Date: 5-9-2024
Subacute combined degeneration (SCD) of the spinal cord is a disease involving the lateral and posterior columns of the spinal cord that can manifest in patients with vitamin B12 deficiency.
Nitrous oxide (N2O) induced SCD of the spinal cord is a result of N2O interfering with the metabolism of vitamin B12 and results in nervous system demyelination.
This is an infrequent complication of N2O anesthesia however cases are rising with recreational N2O use.
Given wide availability of N2O, clinicians must maintain a high index of suspicion when confronting patients with concerning clinical pictures.
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Review of Salvage Therapy for MRSA Bacteremia at Beaumont Health System
Hazem Alakhras, Matthew D. Sims, and Tracey A.H. Taylor
Publication Date: 5-2023
Treating methicillin-resistant Staphylococcus aureus (MRSA) effectively is imperative to reduce mortality rates, as it contributes to a large amount of healthcare-associated bacteremia in the U.S. However, due to the insufficient and sometimes contradicting studies to guide salvage therapy, there is a lack of clear consensus on treatment of MRSA bacteremia after vancomycin failure. The goal of this study is to showcase the salvage therapies of choice for patients with MRSA bacteremia at Beaumont Health System.
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Effect of Comorbidities and Choice of Treatment on Overall Survival in Elderly Patients with Acute Myeloid Leukemia: A Beaumont Experience
Bilal M. Ali, Emma Herrman, James Huang Huang, and Mohammad Muhsin Chisti
Publication Date: 5-2023
First line therapy for Acute Myeloid Leukemia (AML) is 7+3 regimen. It often cannot be used in elderly patients due to intensity. Venetoclax + hypomethylating agent (HMA) is approved for AML treatment in these patients. We investigate the efficacy of this treatment in a community setting where patients do not have the same resources available to them as a large academic center. Primary outcome was survival of patients greater than 60 years of age with a diagnosis of AML who received 7+3 therapy versus those who received venetoclax + HMA. Secondary outcomes included characteristics of those who received the two therapies.
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Risperidone-Induced ITP
Amira Al-Nabolsi, Vraj Tripathi, George Darany, and Omar Khan
Publication Date: 5-4-2023
Immune Thrombocytopenia Purpura is a hematologic condition characterized by a selective decrease in platelet count.
White blood cell and hemoglobin levels remain within normal limits.
Clinical manifestation includes widespread purpuric rash and mucocutaneous bleeding.
-
More Than You Can Swallow: Mycotic Aneurysm, An Uncommon Etiology of Dyspepsia
Hussein Bazzy, Katharine Glover, Steven Jones, James Aldridge, Michael Potes, and Katie Sumnicht
Publication Date: 5-4-2023
Dyspepsia is defined as predominant epigastric pain lasting greater than one month.
▪ Common etiologies of dyspepsia include peptic ulcer disease, medications, and gastroesophageal reflux.
▪ We present a rare case of dyspepsia caused by a mycotic aneurysm due to accidental foreign body ingestion leading to emergent inpatient intervention.
-
Atypical Presentation of Legionnaires' Disease
Hassan Eidy, Barbara Senger, Joshua Steele, and Jolian Kathawa
Publication Date: 5-4-2023
Legionnaires’ disease or Legionellosis is a subtype of pneumonia caused by the gram negative bacilli, Legionella pneumophila.
L. pneumophila serogroup 1 accounts for 50-80% of Legionnaires’ disease.
Patients commonly present with fevers, chills, myalgia, cough and less commonly with confusion, nausea, vomiting, diarrhea, and/or anorexia.
Treatment primarily consists of antibiotics with supportive measures.
Renal and hepatic extrapulmonary manifestations from Legionella are rare, and often present with multisystem involvement when they do occur.
This case highlights a unique, and rare, presentation of Legionnaires’ disease mimicking alcoholic hepatitis with 2:1 AST/ALT transaminitis and physical exam findings.
-
A Bizarre Halloween: A Rare Etiology of Phytobezoar
Katharine Glover, James Aldridge, Tedd March, Jared Grodman, and Jolian Kathawa
Publication Date: 5-4-2023
A phytobezoar is defined as the composition of indigestible food particles found in the GI tract, primarily composed of plant material, such as fibers and cellulose.
Any individual may develop a phytobezoar, but those with altered gastrointestinal anatomy or decreased motility are at highest risk.
They often present with nausea, vomiting, and/or symptoms of gastric outlet syndrome.
Complications include ulcerations, bleeding, bowel obstruction, and/or perforation.
Thus, complete removal is the ultimate treatment.
-
Purr-Ils of the Liver: A Case of Mash Cirrhosis Complicated by Disseminated Pasteurella
Joanna Henry, Alaa Abujame, Cameron Hubbard, Angela Shermetaro, James Hebden, Hussein Bazzy, Jared Grodman, Katie Sumnicht, and Christopher Cooley
Publication Date: 5-4-2023
Pasteurella Multicoda is a gram-negative coccobacillus that is commensal to mammals such as domesticated pets and transmitted to humans by scratches or bites. The extent of infection is often limited to soft tissue, bone, and joint.
Disseminated infection by P. multicoda infrequently is typically associated with peritoneal dialysis.
We present a case of disseminated P. multocida infection with bacteremia and peritonitis in a patient with NASH Cirrhosis
-
Anti-Yo Positive Paraneoplastic Cerebellar Degeneration: A Case of Discovering Fallopian Tube Cancer From Neurological Symptoms
Sydney Jacobs, Alaina Skotak, and Inna Sta Maria
Publication Date: 5-4-2023
Paraneoplastic syndromes are rare neurological disorders associated with cancer at distant tumor sites. Prevalence is ~1-3% of all cancers, with an estimated 17,099 cases in the US in 2021.
▪ Paraneoplastic cerebellar degeneration (PCD) is one subtype, primarily associated with gynecological and breast cancer, especially in women older than 60.2
▪ Can cause significant functional impairment (e.g. abrupt onset truncal ataxia, room-spinning dizziness, dysarthria, and diplopia).
▪ Neurological symptoms often precede cancer diagnosis.
▪ Pathophysiology of PCD: Tumor-induced autoimmunity against cerebellar antigens.4 About 30 types of antibodies, one being anti-Yo antibody (or Purkinje cell cytoplasmic antibody type 1, (PCA-1)) acting on human cerebellar degeneration-related protein.
-
Readmission Rates In Complex Cases Does Review of AVS with Patients/Families Lead to Lower Readmissions?
Nick Leventis
Publication Date: 5-4-2023
-
Development and Evaluation of a Peer Education-Based Ultrasound Curriculum with Emphasis on Clinical Reasoning
Nisha Patel and Arati Kelekar
Publication Date: 5-2023
Point-of-care ultrasonography (POCUS) is being increasingly incorporated in pre-clerkship physical diagnosis courses. However, the development of such a curriculum at many medical schools is limited by financial constraints, the availability of trained faculty, and the recent COVID-19 pandemic. Here, we describe an optional POCUS curriculum that circumvents these barriers while still providing basic image acquisition skills and pathophysiological correlations.
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Changes in Electrocardiographic and Cardiac Implantable Electronic Device Parameters Following Transcatheter Aortic Valve Replacement
Elizabeth Seeley, Luai Madanat, and Nishaki Mehta
Publication Date: 5-2023
Transcatheter aortic valve replacement (TAVR) is known to cause conduction abnormalities leading to the need for permanent pacemaker implantation. However, the impact of TAVR-related conduction abnormalities on cardiac implantable electronic device (CIED) parameters in patients with preexisting devices is not known. We sought to investigate and describe changes in EKG and CIED parameters following TAVR in patients with preexisting CIEDs.
-
A Rare Case of Radial Arteriovenous Formation After Transradial Cardiac Catheterization
Barbara Senger, Hassan Eidy, Andrew Gray, and Robert Grodman
Publication Date: 5-4-2023
In the United States, more than one million cardiac catheterization procedures are performed each year for diagnostic and therapeutic purposes.
▪ Right heart catheterizations allow for direct measurement of right-sided cardiac and pulmonary hemodynamics while left heart catheterizations provide a diagnostic and therapeutic role in those with coronary artery disease.
▪ In 1989, Lucien Campeau proposed the use of a smaller caliber catheter to access the small radial artery as a way to reduce the rates of bleeding complications.
▪ Advantages of utilizing the transradial artery (TRA) approach over the transfemoral artery (TFA) approach include: – Improved patient quality-of life metrics. – Reduced major bleeding and access site complications. – Lower total hospital costs.
▪ Access-site complications including radial artery occlusion and arteriovenous fistula (AVF) formation from TRA are rare and usually of minimal clinical impact.
▪ AVF may present with pain and edema at the puncture site, a pulsatile thrill, and/or visible dilated superficial veins.
-
Liver Injury, Renal Failure, and Pancytopenia after Radioactive Iodine Treatment for Papillary Thyroid Carcinoma A Case Report
Angela Shermetaro, Grant Hupp, and Jordan Bushman
Publication Date: 5-4-2023
Radioactive Iodine (RAI) has been used for diagnosis and treatment of thyroid carcinomas since the 1940’s. Some known side effects include gastritis, radiation thyroiditis, and bone marrow suppression. However, there are minimal reports on radioactive iodine causing drug induced liver injury (DILI) and renal failure.
To our knowledge, this is the first reported case of both hepatic injury and renal failure following RAI treatment.
We describe an 83-year-old female who developed DILI and renal failure after radioactive iodine ablation.
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