Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Concurrent Histoplasmosis & Blastomycosis in a Young Woman.","authors":"Gizem Reyhanoglu, Mohsan Khan, Andrea Venturini","doi":"10.55729/2000-9666.1523","DOIUrl":"10.55729/2000-9666.1523","url":null,"abstract":"<p><strong>Background: </strong>Histoplasmosis capsulatum and <i>Blastomyces dermatitidis</i> are fungi that are uniquely distributed across the United States. Co-infection with both fungi remains uncommon. The literature review of coinfection was limited to three cases. Only two cases were recorded in humans. Infection can yield symptoms ranging from asymptomatic to life-threatening. On radiographic imaging, diffuse reticulonodular infiltrates with hilar or mediastinal lymphadenopathy can be seen. Management depends on the severity of the disease and the patient's immune state.</p><p><strong>Case description: </strong>A 35-year-old female with a medical history significant for HIV and substance use disorder presented to the hospital with severe lower abdominal pain, weakness, and unintentional weight loss. Her symptoms persisted and evolved to include dyspnea and high fevers. Imaging with chest CT revealed diffuse miliary lung patterns. Confirmation of histoplasmosis was noted by in-house blood cultures. Additional testing via send-out laboratory confirmed the presence of <i>Blastomyces dermatitidis</i> antigen. Her hospital course was complicated by acute hypoxic respiratory failure and the patient was intubated. Despite aggressive antibiotic and antifungal therapy, the patient's condition continued to decline. The patient's family decided to transition her care to comfort measures and the patient was palliatively extubated, expiring shortly afterwards.</p><p><strong>Conclusion: </strong>Current treatment of histoplasmosis in immunocompetent individuals depends on the duration of the disease. Acute infections do not warrant treatment. If symptoms persist, a three-month course of itraconazole is recommended. Amphotericin B is considered in patients unable to take itraconazole or for those with severe disease. Blastomycosis ranges from asymptomatic to a deadly pulmonary infection. While spontaneous remission of mildly symptomatic blastomycosis can occur, treatment with itraconazole is often recommended. Amphotericin B is reserved for severe pulmonary infection, disseminated blastomycosis, or central nervous system blastomycosis. Immunocompromised patients represent a population at significantly elevated risk for disseminated fungal disease as well as severe pulmonary infection from fungal disease.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"50-55"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Treatments for Adolescent Vaping Cessation: Are We There Yet?","authors":"Jasleen Kaur, Amanda Rossi, Sofia Adams, Mariginder S Varowal, Lakshit Jain, Mohsin Raza, Zouina Sarfraz","doi":"10.55729/2000-9666.1526","DOIUrl":"10.55729/2000-9666.1526","url":null,"abstract":"<p><p>E-cigarette use among adolescents is a growing public health concern, driven by discreet designs, appealing flavors, and social influences. Despite high addiction rates, most teen users express a desire to quit, though evidence-based cessation tools remain limited. Behavioral interventions, including tech-based programs like <i>This Is Quitting</i> and <i>smokeSCREEN</i>, show promise. Pharmacotherapy, particularly varenicline, may support quitting, though its role in adolescents is still under investigation. Pediatricians must address this issue through empathetic, multifaceted approaches that combine education, behavioral support, and emerging treatments to curb early nicotine dependence and its long-term health consequences.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"68-70"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fecaloma in Chronic Opioid-induced Constipation: A Fatal Case of Stercoral Colitis.","authors":"Claudia Georges, Simardeep Singh, Eskandar Alex Yazaji","doi":"10.55729/2000-9666.1528","DOIUrl":"10.55729/2000-9666.1528","url":null,"abstract":"<p><p>Stercoral colitis (SC) is a rare and potentially lethal condition characterized by severe colonic inflammation resulting from fecal impaction. This disorder is more prevalent among the elderly and vulnerable groups, especially those on chronic opioids. Our case study involves a 56-year-old male with a history of chronic opioid use who faced an acute colonic obstruction due to longstanding constipation. Despite receiving surgical treatment, the patient dies from ischemic bowel complications and multiorgan failure. The case accentuates the complexities of diagnosing and treating stercoral colitis, highlighting the critical need for early identification and proactive therapeutic intervention to prevent fatal outcomes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"41-44"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid Resuscitation Choice and its Effect on Plasma Chloride and Acute Kidney Injury in Severe Acute Pancreatitis: A Randomized Study of Normal Saline vs. Balanced Crystalloids (Physiomax).","authors":"Mandip S Bhatia, Ritu Attri, Ashok K Pannu, Atul Saroch, Saurabh C Sharda, Neeraj Singla, Sakshi Mehta","doi":"10.55729/2000-9666.1543","DOIUrl":"10.55729/2000-9666.1543","url":null,"abstract":"<p><strong>Background: </strong>Acute pancreatitis (AP) is a potentially fatal gastrointestinal condition, often associated with organ failure and acute kidney injury (AKI). Early fluid resuscitation with Normal saline (NS) may lead to hyperchloremia and AKI, which prompted interest in using balanced crystalloids. However, the optimal choice of crystalloid fluid remains uncertain. This study aimed to compare the effects of NS versus Physiomax on plasma chloride levels and AKI incidence during early resuscitation in patients with predicted severe AP (pSAP).</p><p><strong>Methods: </strong>A single-center, prospective, randomized study was conducted between November 2022 and December 2023 at PGIMER, Chandigarh, India. 112 patients with pSAP were enrolled and randomized (1:1) to receive either NS or Physiomax for fluid resuscitation over the first 48 h. Primary outcome was plasma chloride concentration at 48 h. Secondary outcomes included AKI incidence, MAKE-30 events, ICU admissions, and mortality.</p><p><strong>Results: </strong>Baseline and clinical parameters were comparable between groups. At 48 h, plasma chloride levels were significantly higher in NS group (114.1 ± 4.3 mmol/L) versus Physiomax group (108.1 ± 3.2 mmol/L; p < 0.001). AKI occurred in 41 % of NS group while 21.4 % in Physiomax group (p = 0.03). MAKE-30 events were more common in NS group (17.9 % vs. 5.4 %; p = 0.008). ICU admission rates were also significantly higher with NS infusion (28.6 % vs. 10.7 %; p = 0.03). No significant differences in hospital length of stay, mortality, or other complications were observed in between groups (p > 0.05).</p><p><strong>Conclusion: </strong>Physiomax significantly reduced plasma chloride levels and AKI incidence in patients with pSAP, suggesting a potential clinical benefit of balanced crystalloids in early AP resuscitation.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"30-37"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malabsorption of Thyroid Hormone After Small Bowel Resection.","authors":"Nathaniel Lin, Marilyn Temkin, Ella Rosenbloom, Alan Kaell","doi":"10.55729/2000-9666.1530","DOIUrl":"10.55729/2000-9666.1530","url":null,"abstract":"<p><p>Hypothyroid patients on stable long-term oral levothyroxine (T4) dosage are at risk of developing overt hypothyroidism after small bowel (SB) resection. This can happen despite equivalent peri-operative intravenous (IV) supplementation and resumption of preoperative oral T4 dosage when post-operative oral medication is tolerated. This situation is not specifically addressed in any of the major guidelines for T4 oral replacement in this setting and may be underrecognized, leading to diagnostic and management challenges.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"64-67"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Unexpected: Duodenal Ulcer as a Manifestation of Breast Cancer Metastasis.","authors":"Emmanuel Gbadehan, Mohammad Abubaker, Parth Adrejiya, Khwaja Haq, Teresa Varghese, Joy Chaudhari, Gurkeerat Singh, Ashok Kanugula","doi":"10.55729/2000-9666.1542","DOIUrl":"10.55729/2000-9666.1542","url":null,"abstract":"<p><p>Breast cancer typically metastasizes to the lymph nodes, lungs, bones, and liver. However, gastrointestinal (GI) involvement is exceedingly rare, particularly presenting as duodenal ulcers. Such metastases often mimic primary GI malignancies, leading to nonspecific symptoms like abdominal pain, anorexia, bleeding, and vomiting, which can delay accurate diagnosis. Early recognition through appropriate diagnostic evaluations is crucial to prevent disease progression. We report a unique case of an 86-year-old woman with multiple comorbidities who presented with multiple gastrointestinal ulcers. Further investigation revealed these lesions to be manifestations of metastatic breast cancer. This case underscores the importance of considering metastatic breast cancer in the differential diagnosis of atypical gastrointestinal presentations, even in elderly patients without a known history of malignancy.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"99-103"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vancomycin-induced Immune Hemolytic Anemia - A Case Report and Literature Review.","authors":"Yilin Song, Meher Ali, Rukhsar Shaikh, Ashley Bersma, Harsh Y Patel","doi":"10.55729/2000-9666.1539","DOIUrl":"10.55729/2000-9666.1539","url":null,"abstract":"<p><p>Drug-induced immune hemolytic anemia (DIIHA) is a rare complication of drug treatment. The clinical presentation involves rapid dropping of hemoglobin secondary to hemolysis leading to potentially fatal consequences. Over 100 drugs have been reported to cause DIIHA, most commonly cephalosporins. Here, we present a case of vancomycin-induced immune hemolytic anemia. The diagnosis was challenging due to the limited reports of hemolytic anemia induced by vancomycin in the setting of multiple antibiotic administration history. Hemolysis improved after vancomycin cessation and diagnosis was made with positive serological confirmation. Literature review was performed with four reported cases of vancomycin-induced immune hemolytic anemia identified and summarized. Our goal is to promote awareness of vancomycin as an uncommon cause of DIIHA for better management in clinical practice.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"85-89"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instagram in the Clinic: A New Challenge for Patient-Physician Communication.","authors":"Jayashree Ravikumar","doi":"10.55729/2000-9666.1534","DOIUrl":"10.55729/2000-9666.1534","url":null,"abstract":"","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"108-109"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Incredible Impact of Antibiotics on Leukostasis.","authors":"Ranjana Chimauriya, Chiranjibi Mainali, George J Pyrgos, Christopher J Haas","doi":"10.55729/2000-9666.1538","DOIUrl":"10.55729/2000-9666.1538","url":null,"abstract":"<p><p>Leukostasis is characterized by respiratory or neurological issues in the context of hyperleukocytosis, secondary to elevated blood viscosity and WBC plugs (aggregates of mature leukocytes or leukemic blasts physically obstructing the microvasculature leading to impaired tissue perfusion and organ dysfunction). It is rare in Chronic Lymphocytic Leukemia (CLL) unless WBC >500,000/μL. A 67-year-old female presented with severe respiratory distress and altered mental status. She was diagnosed with <i>Streptococcus pneumoniae</i> meningitis and pneumonia. Laboratory diagnostics demonstrated hyperleukocytosis (WBC >440,000/μL) and CLL confirmed by flow cytometry. Imaging showed bilateral acute brain infarcts. After 12 days of antibiotic therapy, her WBC dropped to 40,000/μL, her condition improved, and she was discharged for CLL follow-up. This case illustrates that in cases of CLL complicated by hyperleukocytosis, evaluation and treatment of a superimposed infection may persistently improve hyperleukocytosis and leukostasis.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"75-80"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Gastrointestinal Kaposi's Sarcoma: A Case Report.","authors":"Sandesh R Parajuli, Maya Pillai, Bidisha Baral, Fikru Merechi, Anish Paudel","doi":"10.55729/2000-9666.1525","DOIUrl":"10.55729/2000-9666.1525","url":null,"abstract":"<p><strong>Introduction: </strong>Kaposi sarcoma (KS) is an AIDS-defining malignancy of the vascular endothelium. Gastric KS without skin lesions is rare. We present a case of a newly diagnosed HIV-positive male with gastric KS in the absence of dermatological involvement.</p><p><strong>Case description: </strong>A 25-year-old male with no prior medical history presented with intermittent headaches, weakness, nausea, and abdominal fullness. Examination revealed temporal wasting, conjunctival pallor, and oral thrush. There were no skin manifestations. He was newly diagnosed with human immunodeficiency virus (HIV) (CD4 <35 cells/μL, viral load 276,000 copies/mL) complicated by cryptococcal meningitis and CMV colitis and had lesions suggestive of KS on esophagogastroduodenoscopy (EGD). Gastric biopsy with staining was positive for HHV-8. He received antifungal and CMV treatment, with HAART initiation delayed due to new-onset fever. Despite treatment, his course was complicated by recurrent infections, requiring ICU care. He ultimately passed away due to cardiac arrest three months post-diagnosis.</p><p><strong>Conclusion: </strong>Clinicians should maintain a high index of suspicion for gastric Kaposi sarcoma in newly diagnosed HIV patients with nonspecific gastrointestinal (GI) symptoms, even in the absence of skin lesions.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 5","pages":"56-59"},"PeriodicalIF":0.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12959117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}