Morbidity & Mortality Case Conference 00776886-4. John C. Araujo MD, Ph.D. CC: Nausea and Diarrhea. HPI: Mr. S. is a 62 year old male who presented to the ED at DHMC with one day of nausea and profuse watery diarrhea. HPI Continued :
John C. Araujo MD, Ph.D.
Sulfur and Penicillin -- Rash
Lives in Lebanon.
Employed as a machinist in a local factory assembling motion detectors.
Occasional beer with dinner.
No illicit drug use.
10.0 \ 15.0 / 157
/ 44.6 \
141 | 106 | 47 CK 202
4.2 | 19 | 3.8LFTs WNL
UA: SG 1.019, pH5.5, no ketones, no NIT, trace leuk EST, 39WBC, 21 RBC.
Blood Cx and Urine Cx sent
Assessment:62 yo man with a h/o obstructive uropathy presenting w/ nausea, diarrhea, and L thigh pain out of proportion to exam. Laboratory examination remarkable for a significant bandemia w/o fever or leukocytosis, heme + stool, an abnormal U.A and a normal LE duplex.
How Useful is the Differential WBC Count for Predicting Bacterial Infection?Wasserman, M. et al. “Utility of Fever, White Blood Cells, and Differential Count in Predicting Bacterial Infections in the Elderly.” Journal of the American Geriatrics Society. 37(6) 537-543, 1989.
6.4 \ 15.1 / 82 N 12 B80131| 99 | 99 / 46.3 \ 5.2 | 9 | 7.6
INR 1.4 Ca 8.0 Phos 7.0 Mg .62 Alb 2.4
PTT 39Tbili 0.4 Dbili 0.2 ALT 73 AST 68
CK 1020Cultures: NGTD
EKG: sinus tach w/o ST-T wave changes
Acute on Chronic Renal Failure
Toxic Shock Syndrome
Myositis vs. Fasciitis
Group A Streptoccoci
Mixed facultative organisms
I. Widespread sepsis
A. Acute myocarditis
B. Early bronchopneumonia
C. Difluent spleen
D. Acute myositis, left thigh (S-01-4789)
E. Deep cutaneous fungal infection of the left thigh.
II. Prostatic hyperplasia with focal prostatitis and infarction.
A. Chronic obstructive uropathy.
B. Chronic pyelonephritis with near end-stage kidneys.
C. Focal acute pyelonephritis
D. Urinary bladder hypertrophy.
E. Chronic renal failure (clinical).
III. Other Findings
A. Bilateral lower lobe lung collapse and congestion
1. Focal pleural thickening and fibrosis, bilateral
2. Focal osseous metaplasia in lung.
B. Coronary artery atherosclerosis
1. Congestive heart failure
i. Bilateral pleural effusion, 1.0 liters on each side
ii. Generalized organ congestion (liver, spleen, lungs).
iii. Pericentral hepatic hemorrhagic necrosis
iv. Pedal and scrotal edema
C. Gall bladder adenoma
1) Wasserman, M. et al. “Utility of Fever, White Blood Cells, and Differential Count in Predicting Bacterial Infections in the Elderly.” Journal of the American Geriatrics Society.
37(6) 537-543, 1989.
2)Kaul, R. et al. “Intravenous Immunoglobulin Therapy for Streptococcal Toxic Shock Syndrome - A Comparative Observational Study. CID. 28: 800-7, 1999.