Thanks to Dr. Castaneda for an excellent morning report on Dengue and Chikungunya

Learning Points:
— Dengue and Chikungunya present similarly with typical features including fever, arthralgia, mylagia and headache
— Be sure to include both Dengue and Chikungunya on the differential diagnosis for patients who traveled to endemic areas and present with acute febrile illness
— Treatment consists of supportive care including anti-inflammatory agents and analgesics

Click on these review articles on Dengue and Chikungunya for more information

Coronal section of rat brain showing NMDA-R intense reactivity predominantly involving the hippocampus.
(From Dalmau, et al. 2008. Lancet)

Thanks to Thomas Vu and Dr. Mathisen for a great morning report!

Learning points:
– Peripheral blood has 1000 RBC per 1 WBC. Thus, CSF from traumatic taps should have approximately the same ratio.
– CSF glucose should be 0.6 of serum glucose.
– Empiric treatment of bacterial meningitis should include strep pneumoniae and neisseria meningitidis coverage. Add listeria coverage for age >50 and immunocompromised. Add pseudomonas coverage for history of instrumentation/trauma.
– Consider NMDA-receptor encephalitis in women presenting w/ altered mental status + psychosis, dyskinesias, seizure, autonomic instability.
– Here is a great article from Dr. Josep Dalmau of UPenn looking describing the course of 100 patients with NMDA-receptor encephalitis.

Thanks to Amy Wu for an interesting case of neurosyphilis!

Learning Points
-Tabes Dorsalis is a uncommon condition of slow demyelination of the posterior columns of the spinal cord caused by Treponema pallidum and is most commonly characterized by sensory ataxia and lancinating pains in the limbs.
-Although neurosyphilis is uncommon in the antibiotic era, it can occur at any time after initial infection and requires a high level of suspicion in symptomatic patients, particularly those with HIV.
-Treatment includes 10-14 days of IV penicillin G with serial monitoring of CSF until WBC is normal and VDRL is nonreactive.

–Click here for a comprehensive review of all things syphilis!

Thanks to Dr. John Hollowed and Dr. Rohit Godbole for an excellent morning report on APML

Learning Points:
— APML is linked with the t(15;17) translocation involving the RARa gene on chromosome 17 and the Promyelocytic Leukemia (PML) gene on chromosome 15
— APML is associated with DIC and patients are at high risk for intracranial bleeds
— Early recognition is KEY!
— Treatment includes all-trans retinoic acid +/- Aresenic or Anthracycline-based chemotherapy

Enjoy this great review article by Dr. Wang who discovered all-trans retinoic acid for APML

Thanks to Dr. Sue Zhang for an excellent case and presentation of invasive actinomyces!

Learning Points:
-Findings of multiple liver cysts carry a broad differential but include infection (pyogenic, fungal or parasite) and malignancy.
-Abdominal Actinomyces israelii is has been associated with neglected metal IUD’s.
–Click Here for an excellent article on differential and workup of hepatic cysts.

Thanks to Dr. Thomas Vu for presenting an interesting case of Guillain-Barre.

Learning Points:
— Classic presentation includes progressive, symmetric muscle weakness with diminished or absent DTR’s
— Can be accompanied by numbness, paresthesias, weakness and pain in the limbs
— Associated with albuminocytologic dissociation

Click below for a great review article on Guillain Barre

Source: UpToDate

Thanks to Dr. Amy Wu for a great morning report on pulmonary cocci!

Learning Points:
-Primary infections due to Coccidioides sp. most frequently manifest as community-acquired pneumonia (CAP)
-Keep cocci in your differential for a patient presenting with CAP, especially if they are not clinically improving with empiric antibiotics
-There is a wide spectrum of clinical manifestations; from a subclinical, self-limited illness, to a subacute process known as Valley Fever with respiratory complaints, to disseminated (extrapulmonary) disease (most commonly spreading to bones, skin, and CNS).
-Serologies in the acute phase may be falsely negative
-Since uncomplicated primary infections are usually self-limited, the decision to treat with antifungals can be considered for patients on an individual basis.
-For more on this topic, here is a great article by the Journal of Clinical Microbiology

Thanks to Dr. Hsieh for an excellent morning report on Lung Abscesses

Learning Points:
— Risk factors for developing lung abscesses: peridontal disease, dysphagia, diminished gag or cough reflex, ETOH abuse and seizure disorder
— Common anaerobes: Peptostreptococcus species, Bacteroides species, Fusobacterium species and microaerophilic streptococci
— Common aerobes: Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae (rarely), Klebsiella pneumoniae, Haemophilus influenzae, Actinomyces species, Nocardia species, and Gram-negative bacilli.

Check out this great Medscape article by our own Dr. Jason Bahk and Dr. Nader Kamangar

Thank you Dr. Sue Zhang for a great morning report on a patient with Cushing’s disease!

Learning points:
-Consider screening for hypercortisolism in a patient with hypokalemia, metabolic alkalosis, and hypertension
-Etiologies for Cushing’s Syndrome include 1) Cushing’s Disease (pituitary) 2) Ectopic ACTH-secreting tumor 3)Primary adrenal neoplasm
-In a patient with both hypokalemia and hyperglycemia, make sure to aggressively replete potassium before administering insulin.
—Cushing’s syndrome review article: A thorough review of the epidemiology, workup, etiology, and management of Cushing’s syndrome