Infectious Diseases Case Management Conference 2016-2017

Infectious Diseases Case Management Conference 2016-2017

Infectious Diseases Case Management Conference 2016-2017

Sessions

Topic Session datesort icon
24yo w/neck mass & Fever->EBV; 38yo h/a/Fx3 weeks, then rash->WNV; 74yo from India s/p kidney tnsplnt w/ chronic F & infiltrates->mTB & mold 1/8/16
28 Gambian MV dz 2 mo hospital w/F, granuloma hepatitis, new veg->AFB! ? mngmt; 26 s/p MVA and spine surg w/ h/a/F->Stool grew salmonella 1/15/16
65 lung tplt hip pain new skin lesions SOB->dis VZV; 66 Nigerian RLE weakness abnl brain/spine/chest CT->HIV/PML->new diffuse rash->VZV; h/o spelunking now w/Ca nodes->Histo 1/22/16
Lung tplt w/F abd pain/surface lesions on liver->HSV; FUO/rash->B-cell lymphoma; CLL/BMT/GVHD chonic cough new large mass lesions in lung->nocardia; Vietnamese w/multiple lung changing nodules/spinal lesion->mouth flora(fuso, actino) 1/29/16
Mngmt of non-adherent HIV w/severe MRSA vertebral osteo->Oritavancin; MVA w/liver abscess/ICU, now w/growth on trachea->aspergillus; Traveler from Haiti w/rash, arthritis->Zika virus 2/5/16
AIDS pt w/watery diarrhea->spirochetosis; 72yo w/psoriais on humera w/cough+wt loss past IGRA-negative->mTB; 3yo with rice-sized worms in stool->Dog tapeworm (Dipylidium caninum) ingestion of fleas 2/12/16
Forehead swelling worseing on antbix->B-cell lymphoma; 50yo from India on adalimumab w/F, pulm status worsens after bronch, ?TB->Histo; Recent Ht tplt w/F GPR in BC & pleural fluid->lactobacillus 2/19/16
64yo w/auto-immune hepatitis on azathioprine w/diarrhea & delta-MS->disseminated CMV; 25 yo AIDS w/progressive anemia->parvovirus 2/26/16
Past HCV on Rx for Thymic cancer w/Fever & GNR in blood->campylobacter fetus; 67yo fever, confusion, rash->traveled to Uganda->East African trypanosomiasis (sleeping sickness)! 3/4/16
mngmt of common variable immunodef. w/ recurrent campylobacter infections and diarrhea; 74 yo w/chronic drainage from buttock ->sinus track from RUQ abscess w/actino ? from choley 2 years ago 3/11/16
Asplenic pregnant female w/2-wks F, cough, h/a->Babesia; Mngmt of HIV pt w/recurrent M. xenopi verteb osteo; Complex onc pt w/mult infxn, past C. dif, acute onset of watery diarrhea->Norovirus 3/18/16
Renal tplt w/2 mo of foot infection->madura foot (Eumycetoma); Distant past liver tplt w/diarrhea/renal failure/delta MS->C.dif & CMV; "Survivor" contestent w/F->Rickettsia africae 4/8/16
62yo w/1mo. multiloculated thigh abscess->Salmonella; Ht tsplt w/thigh & ankle cellulitis->Cryptococcus!; 1 yr FUO->Kikuchis/anti-synthetase syndrome 4/15/16
41yo acute abd pain w/vesico-sigmoid fistula->Pylephlebitis!; Discussion of Zika & pregnancy advice; 37yo w/monthly fever & ulcers on tonsilsx3 yrs->PFAPA! 4/22/16
Chonic fluid collection after elbow trauma->M. gordonae; Mngmt of nasophar CA w/culture neg meningitis; Mngmt of worsening CXR while on rx for mTB 4/29/16
Traveler to Africa w/larvae coming out of skin->Putzi/Tumbu fly larvae; Flu-like illnes post blood transfusion in S. America->T. cruzi; Mngmt of syphilis in pregnancy 5/6/16
Mgmt of recurrent Herpes B infection; Change in mental status w/abnl CSF->Eastern Equine Encephalitis 5/13/16
Mgmt of recurrent pyelo due to altered anatomy; Hatian w/enhancing brain stem lesion->?mTB?; Renal/Liver tplt w/new bilat patchy pneumonia->Legionella jamestowniensis 5/20/16
Multiple arm lesions after gardening->nocardia, but sulfa allergic; Recurrent joint pain, now looks like spetic arthritis->RA & mgmt of P acnes in culture; Mngmt of chronic mucocutaneous candidiasis w/R azoles 5/27/16
RA pt recently d/c TNF-blocker w/diarrhea->UC; Egyptian w/dysphagia & CP->Histo!; Cirrhotic w/post-op absc w red hands->Linear IgA bullous Derm; Kidney tplt w/chronic rash on one leg->M. marinum 6/3/16
Healthy 24 yo from Ghana w/new cough and rapid worsening requiring ECMO->mTB; Veteran w/delta MS multiple CNS lesions->Met lung CA; Mgmt of CF lung tplt candidate w/AFB->Segniliparus rugosus 6/10/16
HIV w/diffuse rash->syphilis; 65yo w/encephalopathy p-GI surg->? CJD, ? vasculitis; UC pt on infliximab w/nodular pneumonia->Legionella! 6/17/16
Chin lesion w/drainage->likely actino; MS pt w/chronic diarrhea->Shiga toxin +(EHEC); Ht tplt w/bloody diarrhea and colonic ulcers->strongyloides 6/24/16
22yo w/congenital ht dz now w/ring enhancing brain lesion->actino; 62yo w/distant ht tplt now w/F/D mult spleen&liver lesions->B.henselae endocard; Guatemalan w/F and jaundicex1mo large spleen->babesia 7/1/16
Met carcinoid tumor w/new lung lesion->mucor; Mgmt of dog/racoon rabies exposure; Mult bullseyes lesions->Lyme; Summer viral illness progressing to shock->lethal ehrlichiosis 7/12/16
3rd trimester w/F RLQ pain rapidly critical->Group A strep; 79 yo w/empyema->Listeria!; M&M immunocompromised pt w/ new cough and dense infiltrate/mass in entire left lung->Legionella 7/19/16
AIDS w/mult OIs including past Toxo, now HIV controled with deltaMS/Sz->Toxo relapse; Pt who lived in jungles of Peru for 5 yrs with cachexia&lung cavities->Histo!; 39yo s/p chemo for colon CA with granuloma in spleen (spine&lung)->Sarcoid 7/26/16
IVDA w/chronic eye problem->C.albicans; Aseptic meningitis->HSV2;Mgmt of +MHATP w/neg RPR; neonatal HSV1 infxn 8/2/16
Mgmt 28yo w/cystic lung dz&aspergillus ? rx ? trplt candidate?; AIDS from Sierra Leone w/pulm&CNS dz->likely mTB; Elderly with liquid CA and rapidly progressing lung lesion->Rhodococcus 8/9/16
71 yo w/subacute onset of encephalitis->West Nile; 65 yo veteran w/empyema & chronic discitis->Capnocytophagia; Discussion of Zika testing 8/16/16
31 yo w/recurrent F rash thrombocytopenia->Adult Stills w/HLH; 28 yo new CHF recovering renal dz->Post-strep glomerulonephritis vs. carditis 8/23/16
Mgmt of exposure to bat feces while in Cancun; Hodkins pt w/rapidly cavitating pneumonia->L. maciacernii; Allogeneic tplt w/new brain lesions->melanoma; Vestibular toxicity from gent 8/30/16
Mgmt HIV while on PReP; 70yo w/1 mo illness & concerns about Lyme->Babesiosis; Distant stem cell transplant now w/Bradyrhizobium enterica bacteremia 9/6/16
Filipino w/Ht tplt recent cryptosporidiosis, new h/a, chronic cough->mTB; Ukranian w/worms in mouth->Gongylonema pulchrum 9/13/16
40yo w/necrotic nasal lesion/sinusitis->Cocaine/percocet; 70yo w/anemia F/S abnl chest CT spleen lesion->myelodysplastic syndrome; 50yo w/chronic cough wt loss->HIV/PCP/CMV pneumonitis 9/20/16
Pregnant returning taveler from India w/Fever->Dengue; Veteran w/onset of meningitis in hospital->Crowned Dens Syndrome; kidney transplant s/p trip to Viet Nam w/elevated LFTs->Chronic Hep E 9/27/16
GI case w/numerous polypoid lesions in terminal ileum->Florid reactive lymphoid tissue from giardia; Mgmt of echinococcus liver abscess; Mgmt of Strep intermedius joint & bone infxn w/hardware now in place 10/4/16
ALL, neutropenia bug bites leg lesions->Sweet syndrome; Surgeon w/ 4d H/A fever->Babesia; Prior Ht tplt w/CMV & new infiltrates->PCP 10/11/16
Progressive lung dz in pt on steroids->Nocardia; young female w/subacute delta MS->anti-NMDAr; Lung tplt w/new effusions & declining PFTs->M.kansasii 10/18/16
Gambian in US w/progressive LE weakness->HIV; Female w/PID progressing to spinal cord abscess->Gardnerella!; woman 2mo post-partum w/ascites & peritonitis->PID ? chlamydia 11/1/16
F/C rhabdo->legionella; CLL with recurrent peri-tonsillar abscess->Bcell lymphoma; Rash, migrating lumps->Loa Loa 11/8/16
New HIV/AIDS w/large chronic lesion on hard palate->plasmablastic lymphoma; Chronic HIV/AIDS w/N/V/F abd pain->MAI of liver; Mngmt of positive HTLV-1 serology 11/15/16
15yo traveler to Thailand w/chronic leg ulcers->Burkholderia pseudomallei; 40 yo AIDS w/chronic fever/lymphadenopathy/abd pain not responding to MAC rx->M. genavensae 11/22/16
Mngmt of VRE endocarditis; Cirrhosis with Fever and stroke->crypto; Returning traveler from Mexico w/F and diffuse rash->HHV-6; Returning traveler from Guatemala w/conjuctivitis & diffuse rash involving palms->Zika 11/29/16
Recurrent colon CA w/microscopic worms in liver path->vegetable material from prior perf; Chronic knee pain->Lyme; skin infection after tatoo->M. chelonae 12/6/16
Mgmt of Veteran with fungating lesion in nose/sinus; BMT pt w/progressing lung lesions that cavitate on antifungal->?IRIS?; High Ca++ w/lung nodules->Histo 12/13/16
Update on HIV testing; Mngmt of MAI/M. abscessus lung infxn; Liberian w/30lb wt loss and abd findings->mTB & HIV 1/10/17
HIV w/new hearing & eye problems, rash on scalp->Syphilis w/prozone effect/ PCN desensitization J-H rxn; Breast CA pt w/infxn at mastectomy site-> Resistant M. chelonae; Mngmt of penile fracture complicated by infected hematoma 1/17/17
Nursing home pt w/Staph bacteremia and thick skin rash->Scabies; 70 yo w/chest pain/myocarditis->Legionella mycoarditis; Mngmt of intermitent S. aureau bacteremia in pt w/old AAA graft 1/24/17
73yo chronic hospitalization w/erysipelothrix-like rash->M. chelonae; 22 lung tpts w/mass in back of orbit->PTLD; Returning traveler from India w/abd pain/feve->Typhoid fever; Tendon rupture p-fall->Cx with algae! 1/31/17
88yo w/new asthma abnl xray & bronch growing AFB & nocardia->mngmt; 37 yo w/finger injury nodules up arm and abnl CXR->Sarcoid, M.marinum from arm lesion 2/7/17
Mngmt of M.kansasii in Lung tplt; HIV, renal transplant w/bloody diarrhea->shigella by molecular testing; Mngmt of polymicrobial skin infxn; Crohn's pt on infliximab w/ scalp pain CN findings, hearing->Ramsey Hunt 2/14/17
CNS lymphocytosis & CN finding, ? lymphoma->Lyme; Sierra leone w/Liver & lung dz->Sarcoid vs. TB; Mexican w/brain stem lesion, ? cysticercosis->syringobulbia 2/21/17
Liver tplt w/F & plts of 8K->?CMV iduced ITP; Lung Tplt F and empyema->lactobacillus; Elderly man w/dementia "sarcoid", very abnl CSF->mTb! 2/28/17
Lung tplt w/recurrent C. kruseii infxn->donor derived; Lung tplt w/new F, cough->Cryptococcus (+LP); College student h/o F/S, new rash->syphilis; Mgmt of worsening symptoms in AIDS/MAI (MAI vs. IRIS)->Rx steroids 3/7/17
Mgmt of recurrent brain abscess in pt w/congenital cardio-pulm dz; Lung tplt w/chronic pruritic rash->polyomavirus-7; Tplt pt w/acute necrotic brain lesion->Toxo!; chronic mastoiditis not responding to antibx->Granulomatosis with polyangiitis (Wegners) 3/21/17
ALL w/dyspnea F miliary dz on CXR->BC+ coccidioidomycosis; Mngmt of DVT w/infect thrombus in Ao arch; Mngmt HCV/HIV non-compliant w/meds s/p liver trplt 3/28/17
Elderly man w/F/N/V->Listeria; Homless with bilat leg uclers->fat necrosis; S. African w/HIV & h/o leprosy with painful skin lesions->conversion rxn; Mngmt of AoVR w/ staph endocarditis 4/4/17
Liberian w/h/a->P. ovale; 79yo w/HIV w/FUO->mTB; post Flu B hemorrhagic pneumonia & shock->S. pyogenes toxic shock 4/11/17
19yo ECMO Lung tplt open chest->mucor infxn; CLL RUL pneumonia p-chemo->Legionella (non-type 1); Cases from Bots: rhinocerebral mucormycosis; brain empyema from sinus infxn 4/18/17
Mgmt of thermomyces endocarditis; Veteran w/chronic h/a and acute delta MS->HSV2; Wrist swelling in pt w/prior M. marinum infxn->M. marinum 4/25/17
Acute leukemia w/F/confusion/sepsis->B. Cereus/mgmt; Mgmt GNR meningitis w/PCN allergy->acinetobacter; Dx of body rash in returning traveler from Dominican Republic->Zika (cross rxn Dengue Ab); Veteran w/ acute back pain->Gout! 5/2/17
Indian w/F/N/V/bloody diarrhea->Liver abscess->E. histolytica; s/p pancreatic CA, unremitting cough w/cavitary lesion->bordetella +/-MAC?; voluminous diarrhea s/p multipe rx for C. dif->Salmonella vs lactose intol vs. post-colitis diarrhea 5/9/17
Cambodian w/30lb wt loss, polymyositis, rash->?Syphilis; 36 HIV w/new cough & LUL cavitary, light growth MAI-> management discussion; 32 F/S/LN->mono 5/16/17
Lung tplt w/vaginal lesions & brochial anastomosis site->Malkoplakia (E.coli); Botfly case; College student w/mucositis, skin lesions, some hypoxia->Amox vs. adeno vs. mycolplasma; EBV seriology in a 60 yo w/chronic fatigue 5/23/17
Rx of acute on chronic foot ulcer w/polymicrobial bacteremia->AIN from beta-lactams; Hiker w/fever->anaplasma; Mgnmt of p-surgical sites w/M. chelonae 5/30/17
AML w/cat bit and cellulitis->pasteurella; HIV w/liver dz rx steroids w/ bilateral CXR findings->cryoptococcus!; 66 w/endocarditis->H. parainfluenza 6/6/17
Cambodian thalassemia-Fe overload w/liver abscess->hypervirulent Klebs; New sz's w/lots of sick animal exposures new lung mass->CABA-B receptor enceph from lung CA; Liver tplt w/flu-like illness/pancytopenia, new liver mass->anaplasmosis(hematoma) 6/13/17
26 HIV abd pain diarrhea Eos & new lung that develop while hositalized->EGPA vs hyperEo syndrome; 70 w/new diffuse rash->Anaplasma 6/20/17
Mngmt chronic mouth/jaw lesion now w/draining sinuses & unrevealing studies->should be actino; Peritoneal dialysis w/persistent F on antibx->mTB!; Distant lung tplt w/complications (M.abscessus retropharangeal abscess) w/acute abd->CMV appendicitis 6/27/17
Chronic foot infxn after dog bit/frequent pedicures->AFB; Fever, low plts, high creat->4% babesia; 87yo w/AoVR s/p MVA now w/meningitis->BC+Strep salivarius 7/7/17
Albanian w/liver cyst->echinococcus; Elderly Greek woman w/small lump in nose and thickened skin in nostrils->leishmania; Mngmt of pt w/AVR and thermomyces infxn, thrombotic events, CNS lesion 7/14/17
Pakistani man w/crhonic fistula dz on buttocks->hidradenitis suppurativa - use of biologics; Elderly man w/acute onset of severe hip pain->Erysipelothrix septic arthritis!; IVDA w/delta MS brain lesions abnl CXR->Septic emboli from Serratia endocarditis 7/21/17
Psoriatic arthritis on MTX & biologics w/4 wks swollen finger->M.marinum worsening on rx; Mngmt of MRSA endocarditis w/persistant bacteremia; Stem cell tplt w no B or T-cells ablnl CXR->Aspergillus & MAI, not improving 7/28/17
Indian women w/new sz abnl MRI->prob cysticercosis; 60yo on chemo for CA w/acute meningitis->Listeria; 82 w/wt loss chronic h/a mutiple CNS lesions->?vasculitis vs tumor? 8/4/17
Mngmt of Crohns on infliximab w/+TB test on biologic wants to get pregnant; Haitian w/Crohns on infliximab w/wt loss & abnl CXR->Miliary TB mgmt w/rising LFTs; Skin ulcers 1 yr after visit to Costa Rica->extranodal NK Tcell lymphoma 8/11/17
Ddx: 22yo w/new cardiomyopathy +Legionella antigen; CLL w/worsening lung abscess->CLL; Abd pain and shoulder pain->Lyme!; 16 yo past Lyme w/new facial palsy->Lyme 8/18/17
Mngmt untreated HIV in pregnancy near delivery; Student w/water & machete xposures while in FIji w/skin lesions->Strep, Staph; aBMT w/steroid responsive brain lesions w/new lesions and deltaMS->+GABA-A receptor (also had dead racoon exposure!) 8/25/17
Mngmt of MSSA endocarditis w/CNS emboli, timing of surgery; AIDS with facial lesions after shaving->Trichophyton; Ht tplt with rounded pneumonia->Pseudomonas!: AIDS w/wt loss pain on swallowing->aphthous ulcers 9/1/17
Mgmt of woman h/o anaphylaxis to PCN in labor w/clinda resistant GBS vag culture; returning traveler from Ghana->P. falcip, mgmt of pot severe malaria; 58 yo w/new CVA and rash on lower extr->syphilis 9/8/17
Camper lake-swimming, weeks of progressing nodular body rash->?Rheum (sarcoid, Behcet's); woman w/necrotizing surgical wound->pyoderma; Returning traveler w/fever->Typhoid 9/15/17
Kidney tplt w/acute encephalitis/paralysis & bat, cat, rat, sheep exposure->Powassan virus; Mgmt of ART in a pt w/ h/o various regimens >20yr about to undergo kidney tplt 9/22/17
41yo w/pruritic rash->Chickenpox; DeltaMS hydrocephalus->Listeria vs autoimmune; Cameron native w/Rx'ed P.falcip w/Hgb 4 & high Eos->post artesunate delayed hemolysis also undx'ed strongyloides 9/29/17
Returning traveler from Belize w/scalp lesion->Bot fly; 38yo w/necrotizing tonsilitis->HSV-1; ALL s/p Tplnt, past mucur with sepsis & difuse skin lesions->Clostridum sordellii bacteremia 10/6/17
1mo p-tplnt w/inflam arthritis of elbow->Mycoplasma hominis; Oral ulcers & heel ulcer->hydroxyuria; Lung tplnt w/lower ext rash/lesions post-fall in street->trichophyton 10/13/17
Infectious Diseases Case Management Conference 10/20/17
Infectious Diseases Case Management Conference 10/27/17
Office of Continuing Medical and Interprofessional Education
150 Anatomy/Chemistry Building, 3620 Hamilton Walk
Philadelphia, PA 19104-6061
Contact us: penncme@mail.med.upenn.edu | 215-898-8005
© The Trustees of the University of Pennsylvania
In support of improving patient care, Penn Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.