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12/17/2014

Yaser
Ayush

5250
7896

Watts, Danny
24426993
F6-31
58-year-old African-American male
with HIV/Hep B co- infection
On HAART ((last CD4 340 in
9/2014, currently 196): Truvada
(Emtricitabine Tenofovir)
+Viramune (Nevirapine)
+Kaletra(Lopinavir-Ritonavir).
Admitted for meningitis. MRI with
multiple lesions (cerebritis, not
abscesses per NS). Antiviral
switched due to acquired fanconi
due to Tenofovir. Repeat MRI 12/16
showed progression. NS following,
recommending escalating abx and
repeat MRI in one week.

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Bowers
22432273
F6-32
85 y.o. F with stage IV gastric
cancer presented with shingles
with superimposed bacterial
cellulitis.
Good, Lucien (Transfer from
MICU)
MRN: 10627464
F6-36A
86 y.o. male with a PMH of
Parkinson's Disease, EtOH Abuse
and recent Left hip
hemiarthroplasty 10/16/14 s/p
revision 11/21/14 who was
admitted from Boulevard Temple
11/27 with severe respiratory
distress 2/2 aspiration pneumonia,
requiring intubation and
successfully extubated on
11/29/14. MSSA grew and
antibiotics were de-escalated to
Nafcillin which he completed.
Patient failed swallow evaluation
x3, placed PEG tube.
Developed another RS distress on
12/10. We think new aspiration.
Started on V/C/F on 12/10 and
pan-cultured.. Sputum Cx with E.

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Bacterial meningitis:
Vancomycin+Ceftriaxone+Ampici
llin+flagyl, TEE, CT
chest/abd/pelvis negative.
Repeat LP decrease WBC 3k to
2.6k. Ampicillin stopped 12/11.
One blood cultures from 12/8
fusebacteriu. Switched to
Unasyn. Repeat MRI showed
progression. Repeat on
12/24. If no improvement, NS
will consider diagnostic
approach.
Candidal eshopagitis: will started
on fluconazole 12/12, to
complete 14 days
Hyponatremia: SIADH: fluid
restriction. Check Na q 8.
Hypokalemia: per nephron: 2/2
acquired fanconi. We are not
totally convinced, so we did not
switch.
Adrenal node: f/u with endo as
OP
Dispo: PT/OT: home with 24. Will
need PICC next week
1. Stage IV gastric cancer:
Hospice consulted
2. Shingles with cellulitis:
Vanco and valcyte
3. Constipation: Enema

Aspiration pneumonia: V/C/F started


12/10, Azithro added 12/12 for
Moraxella as secretions are not
improving.
2. Dysphagia: failed swallow eval
X3. PEG tube placed
3. Dispo: PT/OT and DC to BT
4. Hip surgery: on Lovenox for
prophylaxis. Postponed.
5. Hypokalemia: Requiring~40 meq
daily, will need 40 daily on
discharge and close follow up on
levels.

Yaser
F/U Jenny Jan/20

Ayush
Stop date for abx, today
Repeat swallow study

Cloaca and Moraxella. Added


Azithromycin 12/12 for Moraxella
as secretions are not improving.
Blackmon
14224315
F6-37A
Elderly with recent knee
replacement, chronic arthritis of
feet requiring steroid injections,
last time was in August, presenting
with left foot pain and swelling.
Xray read as possible OM vs
septic. MRI:

Corrothers, Leslie
53850022
F6-37B
40 year old Female patient,
Alcoholic, smoker. 2 months
weight loss. 2 days hemoptysis. CT
chest with cavitary lung lesion.

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Possible OM, off Ab, pending MRI

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Cavitary lung lesion: Very broad


differential. Ruled out TB. Started
Rocephin + Clindamycin. S/P
bronch 12/15 and work up done
without biopsy. HIV negative.
High BP. Started on Amlodipine 5
md today.

Yaser
F/U cytology and Micro
Avelox: 3 Weeks
Augmentin 875 TID
F/u Pulmonary and CT in 3
weeks

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F/u Cultures

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Littles
58622806
F6-40B
79 year old female with recent
TIA and residual weakness on
right side (currently resolved),
her work up done at OSF
showed right ICA stenosis.
Presented with generalized
weakness. Positive UA.

UTI: UA showed staph


aureus, Vanc

Pray
61908021
F6-42
40 yo female IVDA actively,
MRSA perinehric abscess
drained and treated in October
and November. Presented for
abdominal pain. Recent UA
showed E Coli, not treated for
it. CXR showed ?lesion.

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UTI: Cultures from recent


botsford visit showed E Coli
Lung mass: will obtain CT without
contrast
Pain, discontinue dilaudid

Anderson
F6-44B
54645349
71 year old male patient with type
II DM, last A1c was 17 in January.
He was discharged on insulin in Jan
which was discontinued by his
visiting physician due to
hypoglycemia. PT/OT consulted
and family contacted regarding
placement as it is unlikely that the
patient will be able to control his
DM by himself.
Lemke, Craig S
34631655

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NKHO: resolved
DM: Restarted lantus
Dispo: PT/OT

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Paravertebral abscess: 12/10: CT


guided aspiration of right

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F6-47A
37 years old male with past
medical history of depression,
chronic back pain secondary
intervertebral disk herniation s/p
laminectomy, fusion of L4-L5 and
posterior fusion of L5-S1 (2008).
Recent multiple ER visits for back
pain, found to have paravertebral
abscess, drained and grew MSSA.

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Pearson, Chris
33735529
F648-A
54 yo man with a history of HIV
(diagnosed 10 yrs ago, not on
therapy, Last CD4 118 in 11/2014,
viral load 440144 copies), HCV,
and actively using cocaine
presents to the ED with a CC of
chill. ED he spiked a fever 39.4

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piriformis muscle abscess. MRI


12/7: Prevertebral ring-enhancing
fluid collection with large
presacral component and
extension in to the right gluteal
region consistent with a large
abscess. Currently on Nafcillin.
MRI showed intraosseous
abscess.
Anemia: Hb ~ 5gm recently, EGD
and colonoscopy ve
Depression and SI: recent psych
hospitalization. See psych recs.
Fever: Antibiotics held. Pancultured
Bed bugs: Isolation
AIDS: Started PCP prophylaxis

Surgery today

Discontinue Bactrim
Check G6PD
If use of IV drugs, V/C