Examples Cases

40yoF with HIV and Decreased LOC

• 40yoF with IV drug use, HIV, HepC presenting with 1 week history of decreased LOC and knee pain.
  • What investigations would you do?
    • CBC, Lytes, Blood cultures, joint aspirate.
    • Send joint fluid for: Cells+ differential, Gram stain, C+S.
    • Blood cutures: + Fungal and Cryptococcal antigen.
    • CD4 count and viral load.
    • HepBsAg, HepBsAb, and HepC serology.
    • CSF for:
      • Opening pressure
      • Glucose/Protein
      • Cells + differential
      • Gram Stain
      • Culture + Sens.
      • Viral PCR (CMV, EBV, VZV, HSV)
      • Cryptococcal Antigen
      • Fungal Cultures.

75yoF with nausea/vomiting/abdo pain

75yoF with nausea/vomiting/abdo pain.  Dxed as viral gastro... sent home... continued fever, chills, N/V/weakness.

Re-presented to ER with cholestatic liver enzymes.  Blood cultures..E.coli (pansensitive) 2/2.

Abod U/S duodenal-CBD fistula, stone.

ERCP - stented fistula + sphincterotomy --> no stone.

CT --> liver abscess + cholangitis.

Liver Abscess --> Amox-clav recommended (Covers G-'s, and anaerobes).  If Penicillin allergic use Cipro-flagyl.  Treat for 6 weeks, F/U with CT abdo in 4 weeks.  

80yo with aspiration event

• With aspiration event presenting with shortness of breath.
• How long after?
  • Pneumonitis vs. Pneumonia (>3-4 days).
• Also has CNSt in the blood.  Do not worry if no artificial valves. (risk of endocarditis is low) Maybe treat if multiple cultures of same organism.