Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

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Epidural Spinal Cord Compression Secondary to Stage IV Esophageal Squamous Cell Carcinoma Arolli, T, D.O. St. Michael’s Medical Center, Newark, NJ Introduction: The incidence of epidural spinal cord compression (ESCC) can only be estimated as many cases are asymptomatic. However, it is important to recognize new cases of ESCC promptly because it may lead to irreversible loss of neurologic function. Our patient presented with ESCC after being recently diagnosed with stage IV esophageal squamous cell carcinoma. Case: A 60-year-old gentleman with past medical history of alcohol abuse and hypertension presented to our hospital with complaint of backache, bilateral leg pain, and generalized weakness for three days. He admitted to a fifteen pound weight loss over the past three months but denied loss of appetite. Patient has had a Cat Scan (CT) of the abdomen which indicated the lesion at esophagogastric junction, a pancreatic body lesion, right adrenal enlargement, and a pancreatic body lesion which were new findings. Esophagogastroduodenoscopy was performed and indicated the presence of an ulcerating mass at distal esophagus. Pathology result has come back as stage IV esophageal squamous cell carcinoma. Oncology consultation was obtained, and patient was discharged with arrangements for an outpatient follow up. He was readmitted two weeks later with a complaint of inability to move his lower extremities bilaterally, unable to stand or walk, with associated urinary incontinence and dribbling. Magnetic resonance imaging (MRI) of the lumbar spine indicated the presence of bony metastatic lesions, 2.6 x 1.1 cm epidural mass lesion at the level L4-L5 compressing the thecal sac and nerve roots from posterior aspects. Patient was diagnosed with ESCC and started on IV decadron with complete bed rest. Radiation oncology consultation was obtained, and patient underwent a few sessions of RT (radiation treatment). He was subsequently cleared for discharge with arrangements for outpatient follow up, with RT as outpatient. Discussion: While many cases of ESCC are asymptomatic, it is important to promptly diagnose them and initiate immediate treatment in order to avoid complications and preserve or improve neurological functioning. The most frequent symptom at presentation is back pain. The majority of cases arise from epidural extension of vertebral body metastases.
<strong>Acute</strong> Interstitial Nephritis Secondary To NSAID Use in A Patient With Concurrent Streptococcal Infection Bajwa, S., D.O. St. Michael’s Medical Center, Newark, NJ Introduction: AIN (cute interstitial nephritis) constitutes 10-15% of kidney disease. It is described as abrupt deterioration in renal function characterized histopathologically as inflammation and edema in the renal interstitium, with involvement of the renal tubules. Etiologies include, hypersensitivity reaction, infection, systemic disease, and transplant rejection. This patient presented with AIN subsequent to use of non steroidal analgesic use, and streptococcal infection. Case: 24 year old African American Female with a past medical history of childhood asthma presented to our hospital with a several day history of diffuse body aches and decreased urination, with associated abdominal pain, nausea, emesis and diarrhea. Her pain was located in the right upper quadrant and epigastric area; and described as a sharp pain that came and went. It was rated at a 6/10 on the pain scale. The emesis was described as non bloody, non bilious, occurring after ingestion of food, and consisting mostly of undigested food particles. Her diarrhea was watery, profuse, non bloody, and not black in color. She stated that each year around the same time she develops a sore throat with cough requiring treatment with antibiotics. She could not recall exacerbating or relieving factors. Several weeks prior, she had participated in heavy ingestion of alcohol on several occasions. At that time she did not feel well and began self medicating over the counter cold medication and non steroidal antiinflammatory medications, which she admitted to taking on a regular basis. Labs on admission showed acute kidney injury with a blood urea nitrogen and creatinine of 25 and 3.4 respectively, no eosinophilia was noted, and the urinalysis showed red color, 3 plus blood, 3 plus protein, 2 plus leukocyte esterase, and greater than 50 white blood cells. Soon after admission the patient became tachycardia and tachypneic, and began to desaturate. She was subsequently intubated secondary to fluid overload. At that time chest x-ray showed frank pulmonary edema and cardiomegally. An autoimmune work up was negative. Streptozyme was found to be positive. Renal function rapidly continued to decline. A CT guided renal biopsy was done and the results showed acute interstitial nephritis. The patient was started on steroids and hemodialysis and her condition improved. Discussion: The presentation of AIN can vary somewhat depending on the particular cause. The classic presentation is symptoms of acute renal failure, with the triad of fever, skin rash, and arthralgias. Labs will most often show acute renal failure with a urinalysis showing increased leukocytes, eosinophiluria, proteinuria, red blood cells, white blood cells, and white blood cell casts. Because presentation can vary, a thorough investigation for cause of acute renal failure is necessary. Often times, when caused by NSAIDs, the the classic triad is not seen. The gold standard for diagnosis of AIN is renal biopsy.
Page 1 and 2: Acute Flaccid Paralysis Accompanyin
Page 3: Adult Typhilitis Associated With Ly
Page 7 and 8: Atypical Presentation for Complex R
Page 9 and 10: Ptosis As A Variant Presentation of
Page 11 and 12: Isolated Gastric Varices as an Etio
Page 13 and 14: A Case of Idiopathic Pulmonary Arte
Page 15 and 16: Diagnosis and Management of Meningi
Page 17 and 18: Surveillance for an Indeterminate H
Page 19 and 20: contralateral trunk/extremities sho
Page 21 and 22: An Unexpected Course of Rhabdomyoly
Page 23 and 24: Severe Autoimmune Hemolytic Anemia
Page 25 and 26: An Uncommon Cause of a Common Sympt
Page 27 and 28: Implications of Epidemiology in Bre
Page 29 and 30: Methicillin-Resistant Staphylococcu
Page 31 and 32: An Unusual Electrocardiogram Presen
Page 33 and 34: Using NSQIP and Zynxhealth to Build
Page 35 and 36: Resident-Run OMM Skills Clinic: Doe
Page 37 and 38: Waves of Health Evaluation of Diabe
Page 39 and 40: A Comparison of Temporal Thermometr
Page 41 and 42: Lactation Assessment Standardized T
Page 43 and 44: Use of Opioids in Management of Chr
Page 45 and 46: Not All Anterior Wall ST Segment El
Page 47 and 48: A Case of Sudden Monocular Blindnes
Page 49 and 50: Can Name Recognition Allow for More
Page 51 and 52: Developing a Treatment Plan for a C
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A Classical Misnomer To Consider: G
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A Case of Mycoplasma Pneumoniae Rel
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Severe Hirsutism in a Patient with
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Case Report: Wernicke-Korsakoff Syn
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A New Diagnosis of Adult Onset Stil
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Acute Brodifacoum Poisoning: A Case
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Inguinal Hernia Containing Endometr
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Simultaneous Rupture of the Anterio
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Idiopathic Pulmonary Fibrosis: A Ca
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Uterine Perforation in a 36 Year Ol
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Co-infection with Lyme Disease and
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Axillary Pseudoaneurysm With Emboli
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Assessing Variability of the Americ
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Delirium and the Family Caregiver:
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in Haiti. Future research can focus
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Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

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