Journal of Brown hospital medicine最新文献

In this paper, the author describes a case in which being curious pushed the medical team to help a patient in an unexpected way. A multidimensional model of curiosity is presented as a roadmap to enhance distinct curiosity skills as a hospitalist.

Uvular ischemia and necrosis are rare causes of sore throat in the post-extubation period. The tissue injury usually results from mechanical compression by the endotracheal tube. We present a case of a 39-year-old man who underwent endotracheal intubation for an elective knee surgery. Following extubation, he reported a persistent sore throat, and was diagnosed with uvular necrosis based on characteristic exam findings. He was successfully treated with conservative measures.

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are among the most common causes of primary nephrotic syndrome in adults. A 32-year-old female with diagnosed MCD, characterized by podocyte effacement and immunoglobulin G (IgG) dusting on initial biopsy, developed worsening renal function unresponsive to first-line treatment with corticosteroids. Persistence of symptoms led to repeat biopsy, which identified collapsing FSGS that was effectively treated with plasmapheresis (PLEX). This case explores the hypothesis that MCD and FSGS lie along a continuous spectrum of podocyte injury and emphasizes the need for early consideration of PLEX in the management of nephrotic syndrome associated with IgG dusting.

A woman in her 20s presented with an 8-week history of nausea and vomiting. She reported poor appetite and unintentional weight loss of more than 10 kg of her body mass. Two weeks before admission, she developed double vision followed by unsteady gait and confusion. Neurological examination revealed bilateral lateral rectus palsy with horizontal nystagmus in her eyes and ataxic gait. Brain MRI revealed T2/fluid attenuation inversion recovery (FLAIR) high signal in symmetrical thalamic hyperintensities suggestive of Wernicke's encephalopathy (WE). The patient was given intravenous thiamine and made a rapid and dramatic recovery. Through this case, we wish to highlight a rare presentation of WE in a non-alcoholic patient precipitated by thiamine deficiency secondary to Cannabis hyperemesis syndrome.

Strongyloides stercoralis is a parasitic infection which is endemic to the subtropics but uncommon in the northeastern United States. Strongyloides is unique in that it can remain latent in asymptomatic carriers for years. The gastrointestinal findings of Strongyloides infection can vary and are not well studied. In some cases, Strongyloides can present with polyp formation and colonic ulceration leading clinicians to suspect malignancy or Inflammatory Bowel Disease. However, corticosteroid administration is contraindicated due to risk of disseminated Stronglyoides infection which has a reported mortality as high as 68%. In this case report we discuss the gastrointestinal and pathology findings of a 71 year old patient with non-disseminated gastrointestinal Strongyloides infection.

Recent changes in healthcare policy, public health priorities, and the spread of misinformation have made it more difficult for hospitalists to secure timely outpatient follow-up after discharge. At the same time, evolving vaccination mandates and insurance coverage gaps have heightened risks to both individual patients and the broader community. By rethinking conventional limits of care delivery, hospitalists can enhance patient outcomes, reinforce public health, and uphold evidence-based practice in an increasingly uncertain environment.

Colonic perforation is an uncommon but serious complication of colonoscopy, which can be extraperitoneal, intraperitoneal, or a combination of both. We present a case of combined colonic perforation in a young woman with ileocecal tuberculosis who experienced colicky pain in the right iliac fossa. She underwent an emergency right hemicolectomy, with no signs of peritonitis observed during surgery. Postoperatively, she was started on antituberculosis therapy and is currently doing well. This case is notable because a thorough review of recent literature identified only three reported instances of post-colonoscopy retroperitoneal cecal perforation.

This article explores the indications for, and the proposed mechanisms behind, the use of dual β-lactam antibiotic therapy in the treatment of MSSA bacteremia.

Babesiosis is an intraerythrocytic tick-borne illness with a rising incidence in the northeastern United States that can be complicated by splenic infarction and atraumatic rupture. We report three cases of splenic infarcts and pose the question: Should certain patients with Babesia species-induced splenic infarcts receive therapeutic anticoagulation? Splenic infarct, with or without rupture, is a rare yet increasingly reported complication of babesiosis. This complication does not appear to be correlated with the degree of parasitemia. There are no guidelines for the management of Babesia species-induced splenic infarcts. While therapeutic anticoagulation may be indicated for splenic infarcts due to other etiologies, the decision to anticoagulate patients with babesiosis remains on a case-by-case basis, as the mechanism of infarct-thrombus formation, coagulation system activation, or red blood cell sequestration-remains unknown. Future studies may be warranted to elucidate the mechanism of splenic infarction secondary to babesiosis, as well as to assess the safety and efficacy of anticoagulation use. Clinicians must be aware of the risk of splenic infarction in Babesia species infections. We report three cases of infection complicated by splenic infarct and discuss the role of anticoagulation. The decision to anticoagulate is individualized and determined by clinical features such as the presence of infarct-related symptoms and overall bleeding risk.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and potentially fatal immunological syndrome characterized by uncontrolled activation of lymphocytes and cytotoxic macrophages, leading to multi-organ dysfunction. We report the case of a young patient with severe acquired HLH who presented with fever, pancytopenia, and acute liver injury associated with central nervous system infection by a bacterial agent rarely associated with this condition (Streptococcus constellatus), alongside a brief review of the current literature. The HLH was secondary to a bacterial infection of the central nervous system, with rapid diagnosis, suspicion, and early immunosuppressive treatment, leading to a favorable outcome. Understanding and recognizing the clinical features of HLH are crucial for early diagnosis, as demonstrated in this atypical case, which highlighted the importance of timely intervention and the role of steroids in managing the disease.