respiratory support, antimicrobial therapy, immunomodulation, and rehabilitation. The possible source of infection remains unclear,
but it is possible that it was acquired due to her immunocompromised state from chemotherapy in conjunction with a recent COVID-19 infection.
A RARE CASE OF NONTYPHOIDAL SALMONELLA CYSTITIS James Kuo MD, Ali Yousuf DO, Gregory Ardoin MD; Department of Medicine, LSU Health, Lafayette, LA.
Introduction: Nontyphoidal Salmonella (NTS) is an exceedingly rare case of urinary tract infection (UTI). It is an enteroinvasive bacterium most frequently associated with gastroenteritis. On rare occasions, NTS has been isolated in urine cultures. It is estimated that they account for less than 0.1% of all UTIs. It is currently unclear what predisposes patients to develop this infection. Older case series suggested an association of NTS UTI with diabetes, immunosuppression, or structural urologic abnormalities. But a larger, more recent study found no significant association with these conditions. Case: A 73-year-old woman with hypertension and hyperlipidemia presented with hematuria and dysuria. She had been diagnosed with a UTI two weeks prior and had completed a seven- day course of nitrofurantoin without symptom resolution. Upon re-presentation to the hospital, the patient was afebrile, hemodynamically stable, and without leukocytosis. Initial urinalysis revealed 500 leukocyte esterase,>100 WBC, no nitrites, 3+ protein, and 3+ occult blood. Computed tomography of her abdomen and pelvis revealed thickening
of the right anterior bladder wall, and no findings concerning for pyelonephritis. She was started on cefepime and admitted to the hospital. Urine culture eventually grew Salmonella species, sensitive to cefepime, trimethoprim/sulfamethoxazole, and fluoroquinolones. Urology evaluated the patient and recommended outpatient cystoscopy. The patient’s hematuria resolved, and she was discharged with a two-week course of levofloxacin. Following discharge, she had a cystoscopy that revealed erythema of the anterior bladder wall but no active bleeding. A repeat urinalysis was negative, and she was started on suppressive antibiotics with trimethoprim/sulfamethoxazole. She had no further recurrence of UTI. Discussion: Hemorrhagic cystitis is a rare complication of NTS infections. Factors predisposing patients to this condition remain unclear and warrant further investigation. The presentation can range from mild hematuria to severe bleeding, leading to clot retention and urinary obstruction. Early recognition and prompt antibiotic therapy are essential in preventing complications.
AN ATYPICAL PRESENTATION OF EXUDATIVE EFFUSION WITH ELEVATED PH AND LDH SUGGESTIVE OF RHEUMATOID PLEURISY Amit Rajkarnikar MD, Department of Medicine, LSU Health, Lafayette, LA
Introduction: Exudative pleural effusion is often associated with malignancy. A high pH (alkaline) in an exudative pleural effusion is not typical, as exudative effusions tend to be more acidic or have a pH close to neutral. This patient presented with pleural effusion negative for malignancy and no signs of rheumatoid arthritis initially but was found to develop rheumatoid arthritis on subsequent follow up.
on the right side. Labs significant were WBC 13.70, eosinophilia 1.11, elevated CRP 42.40. Autoimmune workup showed elevated RA IgA of 31, RA IgM of 41 and Anti-CCP of 115. Chest Xray was remarkable for moderately sized right pleural effusion with airspace disease in the right mid to lower lung. Computed Tomography of the chest without contrast showed moderate to large right pleural effusion with adjacent
compressive atelectasis and few scattered small pulmonary nodules. Thoracentesis was performed. Pleural fluid assessment as follows: RBC 56,000, WBC 6,708, Lymphocyte 33% and Eosinophil 45%, pH 7.74, protein 5.1, LDH 804, glucose 86, cholesterol 117. Fluid cytology was positive for eosinophilic effusion and negative for malignancy. Fluid culture was negative 33
Case: A 45-year-old male with hypertension presented with complaints of progressive shortness of breath with sharp right sided chest pain. Reportedly, he also had 30 lbs. unintentional weight loss in the past 6 months and decreased appetite. The physical exam was positive for decreased breath sounds
Made with FlippingBook Digital Publishing Software