HCA healthcare journal of medicine最新文献

{"title":"<i>Veillonella</i> Discitis: A Rare Presentation and Review of Literature.","authors":"Akankcha Alok, Vidya Sagar Kollu, Gautam Kalyatanda","doi":"10.36518/2689-0216.1737","DOIUrl":"10.36518/2689-0216.1737","url":null,"abstract":"<p><strong>Background: </strong><i>Veillonella</i> is an anaerobic gram-negative coccus found as a commensal organism in the oral, respiratory, gastrointestinal, and genitourinary tract of humans. Rarely, it can cause serious infections by the production of lipopolysaccharide, an endotoxin. Although most <i>Veillonella</i> infections occur in immunocompromised individuals, we herein describe cases of <i>Veillonella</i> discitis, a rare presentation of <i>Veillonella</i>, in immunocompetent patients.</p><p><strong>Case presentation: </strong>The first presented case was encountered in a patient admitted at our facility. All patient data were obtained from the hospital's electronic medical record system. Thereafter, a literature search and subsequent review was done on PubMed with the MEDLINE database, using the term \"<i>Veillonella</i> discitis,\" to obtain other reported cases of discitis caused by <i>Veillonella</i>.We found a total of 9 cases of <i>Veillonella</i> discitis in immunocompetent patients, apart from our patient. It was most frequently found in those aged 60 to 70 years, with no particular association with patient sex. Chronic backache was the most reported presenting symptom, the lumbar spine being the most commonly affected area, with a high number of cases occurring in the presence of an inciting event. Ceftriaxone, amoxicillin, and clavulanic acid were the most commonly used drugs, with an average duration of therapy of 6 weeks.</p><p><strong>Conclusion: </strong>The objective of our study was to highlight the importance of recognizing <i>Veillonella</i> as a potential cause of discitis. We aim to educate medical professionals regarding the presentation of <i>Veillonella</i> discitis, the demographic groups affected, predisposing factors, and the treatment options available.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"733-737"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959737","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":"Assessment of the European Hernia Society Classification of Ventral Hernias and Clinical Outcomes.","authors":"Oluwatunmininu A Anwoju, Ashtyn Barrientes, Connor Hogan, Erik Askenasy, Jacob Greenberg, Keith Jerrod, Scott J Roth, Zuhair Ali, Mike K Liang","doi":"10.36518/2689-0216.1542","DOIUrl":"10.36518/2689-0216.1542","url":null,"abstract":"<p><strong>Background: </strong>Ventral hernias are a common but heterogeneous disease. Communication among key stakeholders (eg, patients, clinicians, administrators, payers, and researchers) can be augmented by a widely utilized classification system. The European Hernia Society (EHS) developed an expert-opinion-based hernia classification system organized by hernia type (primary versus incisional) and size. We sought to assess what components of the EHS ventral hernia classification system were correlated to real-world clinical outcomes.</p><p><strong>Methods: </strong>This was a multicenter cohort study. All hospitals contributing to the database were affiliated with 1 of 6 academic institutions. All adult patients who underwent ventral hernia repair over a 4-year period were included. The primary endpoint was adverse events defined as any major (deep or organ space) surgical site infection (SSI), abdominal reoperation, or hernia recurrence. Utilizing a multivariable Cox regression, factors associated with adverse events were identified. Accuracy was assessed using Harrell's C concordance statistic.</p><p><strong>Results: </strong>Of the 2385 patients who underwent repair of ventral hernias (primary n = 810, 34.0% and incisional n = 1575, 66%), with a median follow-up of 11.1 months, 27.5% suffered adverse events including major SSIs (5.7%), hernia recurrences (12.1%), and abdominal reoperations (9.7%). In the overall cohort and the primary ventral hernia subgroup, all hernia-specific variables were associated with adverse events. American Society of Anesthesiologist score, low albumin, and prior SSI were associated with adverse events in the overall cohort and primary ventral hernia subgroup while surgical approach was associated with adverse events in the overall cohort and incisional ventral hernia subgroup. On multivariable Cox regression analyses, incisional ventral hernia and larger hernia width were independently associated with adverse events.</p><p><strong>Conclusion: </strong>Hernia size and type (primary versus incisional) from the EHS ventral hernia classification system were associated with clinical outcomes. Additional factors, including patient and operative factors, also impact outcomes. Our model allows key stakeholders to communicate more clearly regarding the challenges and outcomes of various patients with diverse ventral hernias.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"649-659"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959833","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":"Investigating the Effects of Nosocomial <i>Clostridioides difficile</i> Infection Among Acute Leukemia Patients: Insights From the 2020 National Inpatient Sample.","authors":"Zubair Hassan Bodla, Mariam Hashmi, Fatima Niaz, Umer Farooq, Muhammad Jahanzeb Khalil, Farhan Khalid, Kipson Charles, Christopher L Bray","doi":"10.36518/2689-0216.1748","DOIUrl":"10.36518/2689-0216.1748","url":null,"abstract":"<p><strong>Background: </strong>Rising nosocomial <i>Clostridioides difficile</i> infections pose high risks, especially for immunocompromised leukemia patients, necessitating targeted research to enhance patient care and outcomes.The objective of this study was to investigate the impact of nosocomial <i>Clostridioides difficile</i> infections (CDI) on patients hospitalized with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).</p><p><strong>Methods: </strong>Our study was a retrospective analysis of adult patients hospitalized with a primary diagnosis of ALL or AML, using the Nationwide Inpatient Sample (NIS) database for 2020. Primary outcomes included the incidence of nosocomial CDI and all-cause inpatient mortality. Secondary outcomes included hospital length of stay, resource utilization, and morbidity. Statistical analyses were conducted with STATA (address). Fisher's exact test was utilized to compare proportions, while the Student's t test was employed for continuous variables. Multivariate logistic and linear regression analyses were used to adjust for confounding variables.</p><p><strong>Results: </strong>We found in 21 135 ALL and 58 560 AML adult patients that the CDI incidences were 2.77% and 3.0%, respectively. ALL and AML patients with CDI had adjusted mortality odds ratios of 3.02 (<i>P</i> = .003) and 1.51 (<i>P</i> = .02). Hospital length of stay was extended by mean differences of 10.16 days (ALL) and 8.33 days (AML) for those with CDI compared to those without it. In addition, patients with CDI displayed a significantly higher incidence of acute kidney injury, sepsis, vasopressor use, and intensive care unit admissions.</p><p><strong>Conclusion: </strong>This study highlights the significant impact of CDI infections on health outcomes for leukemia patients, emphasizing the need for robust infection control measures, early detection, and aggressive management of CDI to improve patient outcomes and minimize healthcare costs.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"681-692"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959469","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":"behind the curtain.","authors":"Angelina Hong","doi":"10.36518/2689-0216.1773","DOIUrl":"https://doi.org/10.36518/2689-0216.1773","url":null,"abstract":"<p><p>Description One of my favorite themes in medicine is the concept of identity. Medicine is layered. It is continually saving lives, expanding in capabilities, and recruiting new students. But how does it shape us, and where does one draw the line between self and profession? Physicians are classically a symbol of hope and healing. But medicine is challenging physically, emotionally, and spiritually. Add on top of that the daily burdens of our personal lives, and the responsibility can become quite heavy, making it difficult to walk with a smile every day. There is a time to stand behind a \"curtain\", for some longer than others, and patients and perhaps even peers may never see the full person behind it. This poem is about those individuals who must carry this duality.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"761-762"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959834","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":"A Case of Xylazine-Induced Necrotic Skin Ulcerations in an IV-Drug User in Florida.","authors":"Mark Zaki, Cynthia Dillon, Anjali Patel, Barbara Gracious","doi":"10.36518/2689-0216.1695","DOIUrl":"10.36518/2689-0216.1695","url":null,"abstract":"<p><strong>Introduction: </strong>As illicit drug manufacturers find new ways to market their products and increase their profit margins, multiple contaminants have found their way into the illicit drug supply. The newest addition, xylazine, also known as \"tranq,\" has spread through the city of Philadelphia and has recently been gaining ground across the United States, including in the state of Florida.</p><p><strong>Case presentation: </strong>This case describes a 37-year-old male with a significant past psychiatric history of severe polysubstance intravenous (IV) use, including fentanyl and methamphetamine. He was comorbid with other mental and physical conditions and presented to the emergency department with acute psychosis and worsening multi-digit ulcerations. The patient reported that the ulcerations started and progressed since he began injecting fentanyl cut with tranq. The patient was hospitalized for over 30 days due to his complex psychiatric illness as well as complications related to his ulcerations. Over the course of the hospitalization, the ulcerations began to heal, which was likely due to stopping IV drug use and receiving IV antibiotics in a restricted setting.</p><p><strong>Conclusion: </strong>Continued use of IV drugs that are contaminated with xylazine or other dangerous additives can lead to increased morbidity and mortality. Suspicion of xylazine contamination should be prompt in patients with a history of IV drug use, skin ulcerations, and suspected opiate overdose that is unresponsive to naloxone. Further research on and awareness of the presence of xylazine in illicit drug supplies across the country is crucial to the prevention and early detection of xylazine-related complications.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"713-719"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959807","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":"Treatment Analysis of Very Early and Early Onset Psychosis in the Youth Inpatient Setting.","authors":"Acelyne Marie Summerson, Jordan Kalosieh, Sindhura Kompella, Clara Alvarez Villalba, Yukthi Kodali","doi":"10.36518/2689-0216.1637","DOIUrl":"10.36518/2689-0216.1637","url":null,"abstract":"<p><strong>Background: </strong>The United States Food and Drug Administration approved 6 atypical antipsychotics for pediatric treatment of schizophrenia. However, little has been published on the effectiveness of these medications in the acute treatment setting of adolescents with psychosis. Since the clinical uncertainty and poor prognosis proceeding the early onset of schizophrenia has a significant impact on a child's development, there is a critical need for evidence-based data on this population. The aim of our study was to investigate the effect of various antipsychotics on young patients admitted to the inpatient ward presenting with acute psychosis.</p><p><strong>Methods: </strong>A retrospective analysis was performed to review the medical records of the patients with specified schizophrenia disorders who were admitted to the inpatient psychiatric unit for treatment with antipsychotics. We analyzed the efficiency of treatment by measuring 30-day readmissions (yes/no), number of readmissions in 30 days, and the length of stay in the inpatient ward. Negative binomial regression and binary logistic regression were used to count the discrete occurrences of an outcome and predict the likelihood of that outcome.</p><p><strong>Results: </strong>We analyzed the medical records of 1117 patients who were assigned to groups based on whether they were treated with aripiprazole (31.9%), risperidone (26.0%), quetiapine (16.2%), and olanzapine (26.0%). Pairwise comparisons revealed receiving risperidone increased the log count of days by an incidence response ratio of 1.15 (1/0.87) compared to receiving aripiprazole (<i>P</i> < .05, 95% CI [0.76, 0.98]). Similarly, quetiapine increased the count of hospital days by a factor of 1.22 (1/0.82) (<i>P</i> < .01, 95% CI [0.70, 0.94]), as well as olanzapine by a factor of 1.23 (1/0.82) compared to receiving aripiprazole (<i>P</i> < .001, 95% CI [0.72, 0.93]). The number of admissions in 30 days was not significantly associated with medication groups (χ² = 3.93, <i>P</i> = .270) when controlling for other variables. The medication group was also not significantly associated with the likelihood of readmission (χ² = 5.594, <i>P</i> = .133) when controlling for other variables.</p><p><strong>Conclusion: </strong>Aripiprazole was significantly associated with shortening the log count of days (χ² = 21.82, <i>P</i> < .0001) when compared to olanzapine and quetiapine. There was no statistical evidence to conclude a difference in readmission rates when comparing medication groups. To our knowledge, these results provide the largest cohort describing the efficacy of different antipsychotics for acute stabilization of psychosis in the inpatient setting.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"661-670"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959714","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":"Hemophagocytic Lymphohistiocytosis in a Critically Ill Patient: A Case Report of a Potentially Fatal Entity.","authors":"Ali Khreisat, Inna Mikaella Sta Maria, Giovi Grasso-Knight, Meghan Mansour","doi":"10.36518/2689-0216.1741","DOIUrl":"10.36518/2689-0216.1741","url":null,"abstract":"<p><strong>Background: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a non-neoplastic proliferation and macrophage activation that induces cytokine-mediated bone marrow suppression and features of intense phagocytosis in the bone marrow and liver, leading to multi-organ dysfunction and ultimate failure. The diagnosis of HLH in an intensive care setting is challenging, and it is associated with high morbidity and mortality. HLH-94 is the standard protocol for treatment, consisting of dexamethasone and chemotherapy like etoposide.</p><p><strong>Case presentation: </strong>We present the case of a 73-year-old woman who had a prolonged hospitalization for vomiting, diarrhea, and dehydration. Her conditions were complicated by acute refractory pancytopenia on the 12th day of admission, leading to multi-organ failure, including anuric renal failure requiring renal replacement therapy and respiratory failure requiring intubation. After a thorough workup, she was diagnosed with HLH using HLH-2004 diagnostic criteria and confirmed by a bone marrow biopsy. She was started on supportive therapy and high-dose intravenous dexamethasone with an appropriate clinical response. Her pancytopenia improved, and she no longer required ventilator support for respiratory failure or dialysis for renal failure. Unfortunately, her hospital course was complicated by a sentinel event leading to her death.</p><p><strong>Conclusion: </strong>This case emphasizes that early recognition and treatment initiation of HLH are crucial to prevent adverse outcomes and mortality. Treatment should be tailored based on the underlying HLH trigger, as chemotherapy-based treatment regimens may result in overtreatment and unnecessary toxicities. Further studies are needed to increase clinicians' awareness and management of secondary cases of HLH.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"745-749"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959500","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":"Apocrine Breast Cancer With Psammoma Bodies in a Male Patient.","authors":"Alena Bashinskaya, Eric W Baum, Michael B Morgan","doi":"10.36518/2689-0216.1768","DOIUrl":"10.36518/2689-0216.1768","url":null,"abstract":"<p><strong>Introduction: </strong>While male breast carcinoma is a relatively uncommon occurrence, its incidence is on the rise, potentially attributed to sporadic pathophysiological mechanisms, primarily involving hormonal imbalances. Invasive apocrine carcinoma represents a small fraction of global breast malignancies, with limited instances reported among male patients in the literature. The clinical presentation of an apocrine breast carcinoma closely resembles that of other breast cancer subtypes, as it is most often described as a solitary ulcerative nodular lesion occupying a retro-areolar region of the breast. Herein, we describe a novel case of an apocrine male breast carcinoma metastasizing to the skin, given that past cases had presented ab initio in the subcutaneous breast tissue. Furthermore, we discuss the unusual histopathology encountered in this entity such as the presence of psammoma bodies.</p><p><strong>Case presentation: </strong>In this case report, we outline the clinical presentation of an 80-year-old male with a history of prior breast cancer and mastectomy, performed 9 years before this dermatologic consultation. Upon a physical examination, a singular nodular lesion on his right breast was discovered, leading to a biopsy. Subsequent histological analysis identified an apocrine cell carcinoma characterized by numerous psammoma bodies, an unusual occurrence in breast tissue. Consequently, the patient received a diagnosis of relapsing breast apocrine carcinoma.</p><p><strong>Conclusion: </strong>Cutaneous metastases arising from apocrine breast carcinoma are infrequent in male patients. The precise diagnosis of invasive apocrine breast carcinoma hinges on the accurate identification of immunohistochemical markers and a clear morphological profile. A notable correlation has been observed, particularly in positive expressions of gross cystic disease fluid protein-15 (GCDFP-15) and androgen receptor. However, due to the rarity of this presentation, there is limited data on treatment modalities. Ongoing studies are investigating the potential role of anti-androgens in the treatment of apocrine breast carcinomas.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"751-757"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959822","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":"Hemophagocytic Lymphohistiocytosis Due to Ehrlichiosis: A Case Series.","authors":"Ajay Iyer, Mattias D'Anna, Shruti Verma, Thomas Pritchard, Vladimir Begilman, Himal Bajracharya, Kaveh Naemi","doi":"10.36518/2689-0216.1639","DOIUrl":"10.36518/2689-0216.1639","url":null,"abstract":"<p><strong>Background: </strong>Hemophagocytic lymphohistiocytosis (HLH) is an immunologic syndrome characterized by excessive inflammation and tissue injury due to uncontrolled activation of the phagocytic system. The underlying mechanism is a lack of downregulation of activated macrophages and lymphocytes by natural killer and T cells. Unfortunately, the diagnosis is often delayed or missed due to the rarity of the disease, decreased awareness, and clinical picture variability. Ehrlichiosis is becoming a more prevalent tick-borne illness in endemic regions and a relatively uncommon but increasingly considered cause of HLH.</p><p><strong>Case presentation: </strong>We describe the cases of 2 patients diagnosed with secondary HLH as per the 2004 HLH criteria, with the trigger secondary to ehrlichiosis. Our first patient presented with a febrile illness and a remarkably elevated blood ferritin concentration. He ended up meeting HLH criteria despite having a negative bone marrow biopsy. Patient 1 had significant clinical improvement in vitals and had a down-trending ferritin with steroids, doxycycline, and intravenous immunoglobulin. The second patient presented with severe systemic involvement and hemodynamic instability. She was found to have HLH with a positive bone marrow biopsy and a positive Ehrlichia PCR. Patient 2 had significant improvement in her hemodynamic instability with the use of anakinra and doxycycline.</p><p><strong>Conclusion: </strong>Raising awareness about HLH is imperative for early diagnosis and trigger-directed treatment, which can help in preventing the disease's severe complications. There are an increased number of reports of Ehrlichiosis progressing to HLH. Early identification and treatment with doxycycline, with the use of immunomodulatory treatment in severe cases, has shown favorable outcomes.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"701-706"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959555","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":"Evaluation of a Patient With a Severe Systemic Inflammatory Response to Nitrofurantoin.","authors":"Brigitte Vanle, Timothy Beatty","doi":"10.36518/2689-0216.1738","DOIUrl":"10.36518/2689-0216.1738","url":null,"abstract":"<p><strong>Background: </strong>Nitrofurantoin is a prevalent antibiotic used to treat urinary tract infections. Despite nitrofurantoin's general safety, it can cause serious side effects, including acute pulmonary toxicity, fulminant hepatitis, and severe systemic inflammatory responses, which may mimic conditions such as ischemia and infection. However, reports of acute systemic inflammatory response syndrome after nitrofurantoin ingestion are uncommon in medical literature.</p><p><strong>Case presentation: </strong>This case describes a severe systemic inflammatory response syndrome in an 85-year-old woman presenting with hypoxia, altered mental status, and profound leukocytosis after exposure to a single dose of nitrofurantoin.</p><p><strong>Conclusion: </strong>Herein we report on a patient with suspected bacteremia and urosepsis. Who was treated with broad-spectrum antibiotics. However, the antibiotic used to treat the patient's urinary tract infection caused an altered mental status and systemic inflammatory response. Therefore, it is crucial for clinicians to consider iatrogenic and medication-induced etiologies for altered mental status.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 6","pages":"739-743"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959384","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}