American journal of hospital medicine, volume 6, issue 1 (2022 January-March)
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Item A solitary red nodule on the wrist: bacillary angiomatosis in a patient with lymphoplasmacytic lymphoma(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-01) Ishii, Lisa; Boyd, Alan S.A 54-year-old male with well-controlled human immunodeficiency virus (HIV) presented with fevers and a red nodule on the wrist. Two weeks previous, he was scratched by his cat. His medical history included lymphoplasmacytic lymphoma (LPL) with Waldenstrom macroglobulinemia. A solitary 1.7cm red nodule was present on the right wrist (Figure 1). He was febrile to 103F. A complete blood count showed baseline anemia and thrombocytopenia. The complete metabolic panel was unremarkable. His CD4+ T-cell count was 466 cells/mm3 (reference 410-961 cells/mm3), and his HIV viral load was undetectable. Historically, the patient's CD4 nadir was 274 cells/mm3. The patient underwent shave removal of the visible nodule. Histopathologic examination of the nodule demonstrated diffuse dermal vascular proliferation (Figure 2). Gram, Gomori methenamine silver, acid-fast bacillus, and human herpesvirus-8 stains were negative. There was focal uptake within the dermis with Warthin-Starry stain (Figure 3). Tissue and blood cultures were negative. Polymerase chain reaction (PCR) from the tissue sample was positive for Bartonella henselae DNA, consistent with a diagnosis of bacillary angiomatosis (BA). The patient was started on a 3-month course of doxycycline. At his follow-up appointment one month later, he continued to be afebrile. The biopsy site healed with a circular scar without recurrence.Item Anti-NMDA receptor encephalopathy secondary to an ovarian teratoma(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-01) Krupadev, Vinay; Johnson, Samuel; Arogundade, Elizabeth; Jones, CatherineThe following case highlights the diagnosis and treatment course of a previously healthy female adult patient who was treated initially for presumptive psychosis and later found to have anti-NMDAR encephalitisItem Development of warfarin-induced, non-uremic calciphylaxis following recovery from COVID-19 infection with acute renal injury -- a report of a case.(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2022-01) Halle, Briana; Ishii, Lisa; Zwerner, Jeffrey P.; Parker, Eva RawlingsHerein we report a case of an obese female presenting with calciphylaxis after a prolonged hospital course due to COVID-19, with multiple complications including now-recovered acute renal failure and deep venous thrombosis requiring treatment with warfarin. Two months after discharge, she presented with new, painful, ulcerated plaques on the thighs and was diagnosed with calciphylaxis. Throughout the COVID-19 pandemic, cutaneous manifestations of SARS-CoV-2 infection have been increasingly characterized, yet non-uremic calciphylaxis is infrequently observed. Despite its rarity, our case highlights the importance of clinician awareness of the potential association of COVID-19 as an additional trigger for calciphylaxis, especially in patients with multiple risk factors. We also urge physicians to be aware of delayed onset in the presentation of calciphylaxis after renal recovery.