John Cinicola

UPMC Central Pa

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Evelyn Calderon Martinez

UPMC Central Pa

Saketram Komanduri

UPMC Central Pa

Pramil Cheriyath

Hackensack Meridian Health

Samanta Landazuri-Navas

Universidad de Las Américas

Cassiopia Cary

Pinnacle Clinical Research

Manjit Jhajj

Pinnacle Clinical Research

Richard Evans

University Hospitals Birmingham NHS Foundation Trust

Venkata Subhash Gorrepati

University of Florida

Vinod Nookala

Community Medical Center

Raúl Cantú-Hernández

Tecnológico de Monterrey

Cooperative Institutions

UPMC Central Pa

University of Pittsburgh Medical Center

Penn State Milton S. Hershey Medical Center

Harrisburg Hospital

Universidad de Las Américas

University of the Americas

Baylor College of Medicine

Ocean Medical Center

Johns Hopkins University

University of Houston

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A rare case of fibrostenotic endobronchial tuberculosis of trachea

Annals of Medicine and Surgery (2015)

Cassiopia Cary Manjit Jhajj John Cinicola Richard Evans Pramil Cheriyath

Endobronchial tuberculosis (EBTB) is a sequelae of pulmonary tuberculosis (TB) that extends to the endobronchial or endotracheal wall causing inflammation, edema, ulceration, granulation or fibrosis of mucosa and submucosa. This case depicts a 20 year old foreign-born woman with a history of active pulmonary TB on anti-TB chemotherapy, who presented with worsening stridor, dyspnea, cough and weight loss. The disease state was diagnosed with multiple modalities including, spirometry, CT scan of the neck, and bronchoscopy. The biopsies of the tracheal web revealed fibrotic tissue without any granulomas or malignancy establishing the diagnosis of EBTB. Serial balloon dilations and anti-neoplastic therapy with Mitomycin C was used to accomplish sufficient airway patency to relieve her symptoms. ETBT is a rare consequence of TB, which although has a low incidence in the United States, so physicians should have a high clinical suspicion based on the need for prompt intervention.

Chronic Cough

Submucosa

10.1016/j.amsu.2015.10.007

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Citations (9)

Postoperative cognitive dysfunction: A case report and literature review

Case Reports in Internal Medicine (2017)

Gurpreet Singh Margaret M Cinicola Naveen R Parva John Cinicola Venkat G Muvva

Background: Postoperative cognitive dysfunction (POCD) is loss of cognition especially in memory and executive function that can extend from a few days to a few weeks after surgery. It is more common in older adult patients. We present a case featuring a typical progression of POCD along with its associated preoperative risk factors.Case report: A 65-year-old male patient with an extensive past medical history including generalized anxiety disorder, hypertension and hyperlipidemia initially presented to the emergency department for chest pain. Coronary artery bypass graft (CABG) was performed under general anesthesia with Propofol, Fentanyl, Rocuronium and Midazolam. The patient tolerated the procedure well. After the procedure, his stay was complicated by delirium and altered mental status. All reversible causes were investigated and eliminated as likely causes. Later, the patient was sent home after a prolonged hospital stay. Following discharge, he had multiple admissions to the hospital for altered mental status, and his mental status has not reached baseline again. Family has been confident that the patient’s psychological and cognitive symptoms began following the CABG.Conclusion: We present this case to highlight the heightened incidence of postoperative cognitive decline in patients over sixty undergoing major surgery. We also present a comprehensive review of the current literature on the risk factors, clinical manifestations, and pathogenesis of POCD.

Past medical history

Postoperative cognitive dysfunction

10.5430/crim.v4n4p37

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Chronic Oral Amiodarone as a Cause of Acute Liver Failure

Journal of Medical Cases (2023)

Evelyn Calderon Martinez Samanta Landazuri-Navas Gizem Kaya John Cinicola

Acute liver failure (ALF) is a rare condition that can have a variable clinical course and potentially fatal outcomes. Medication toxicity is a known etiology, however liver failure induced by amiodarone is rare and has been reported mostly in the setting of intravenous (IV) infusion. We present an 84-year-old patient who developed ALF after chronic use of oral amiodarone. The patient received supportive care and her symptoms improved.

Etiology

10.14740/jmc4044

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The importance of peripheral blood films.

PubMed (1992)

Marianne Lamb John Cinicola

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EYE SWELLING: A RARE CASE OF LOCALIZED GRANULOMATOSIS WITH POLYANGIITIS

CHEST Journal (2023)

MYDAH HASHMI Babray Laek PALI SINGH Suguni Loku Galappaththy A. F. Coca

Granulomatosis with polyangiitis

Microscopic polyangiitis

10.1016/j.chest.2023.07.114

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S46 Persistent Risks of TNF Inhibitors Despite Benefits: 31 Years Old Pregnant Patient With Crohn’s Disease

The American Journal of Gastroenterology (2022)

Gizem Kaya Evelyn Calderon Martinez Nima Pourhabibi Zarandi Khaldoon Aljassani John Cinicola

Introduction: TNF inhibitors have been used to treat inflammatory bowel diseases for the past 2 decades. These medications act to control acute flares as well as reach and maintain remission. However, side effects remain a large concern. Physicians should maintain a low threshold of suspicion for both opportunistic infection and malignancy, particularly lymphoma and leukemia, in their patients taking TNF inhibitors. Case: A 31-year-old 19 weeks pregnant female (G1P0, GA 19w0d) with Crohn's disease presented with one month of right lower quadrant pain, fever, chills and fatigue. She had an incision and drainage performed for right thigh folliculitis 6 weeks before, and since then had continued pain in the right inguinal and lower quadrant area. She has been on adalimumab and azathioprine since 2015 with no recent flare ups; her last dose of adalimumab was given just before this admission. On admission, patient was febrile, tachypneic, and tachycardic, with leukocytosis. Given concern for sepsis in the setting of pregnancy, she was admitted to ICU and started on vancomycin and ampicillin-sulbactam for broad coverage. Imaging revealed extensive retroperitoneal lymphadenopathy along the right iliac chain and right inguinal region. She underwent an excisional biopsy from right inguinal lymph nodes. While final pathology results were pending, respiratory symptoms worsened, leading to an increased oxygen requirement. Chest CT showed progressive patchy ground glass opacities. Azithromycin and steroids were started, with pentamidine to cover possible Pneumocystis carinii pneumonia (PCP). On hospital day 15, the patient had a spontaneous vaginal delivery of a nonviable fetus. She experienced multi-system organ failure in following days, requiring vasopressor support, intubation, mechanical ventilation, and continuous renal replacement therapy due to severe metabolic acidosis. Antibiotics were broadened to vancomycin, meropenem, clindamycin, micafungin, azithromycin and pentamidine without meaningful clinical improvement. Multiple cultures, including a bronchoalveolar lavage, showed no pathogen. Final pathology revealed ALK-positive anaplastic large-cell lymphoma, a type of non-Hodgkin lymphoma, and the patient was started on chemotherapy with cyclophosphamide and doxorubicin. She had drastic clinical improvement following the first dose. She was then weaned off vasopressors and extubated. Antibiotics were discontinued, except atovaquone for PCP prophylaxis, and the patient was discharged on hospital day 26. Discussion: It is hypothesized that T cell dysfunction is involved in the pathogenesis of Crohn's disease and studies have reported that patients with chronic inflammatory disorders might have an increased baseline risk of lymphomas regardless of TNF antagonist treatments. As physicians, we maintain high suspicion for opportunistic infections in IBD patients on TNF inhibitors presenting with signs of a systemic inflammatory response. However, clinical features associated with sepsis– such as fever, tachycardia, tachypnea, and leukocytosis– can indicate malignancy as well. Some lymphomas cause inflammatory responses that respond to chemotherapy. This case emphasizes the importance of avoiding singular focus on opportunistic infection in IBD patients.

Leukocytosis

10.14309/01.ajg.0000897692.91003.89

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Corrigendum to ‘A rare case of fibrostenotic endobronchial tuberculosis of trachea’ [Ann. Med. Surg. 4 (2015) 479–482]

Annals of Medicine and Surgery (2016)

Cassiopia Cary Manjit Jhajj John Cinicola Richard Evans Pramil Cheriyath

[This corrects the article DOI: 10.1016/j.amsu.2015.10.007.].

10.1016/j.amsu.2015.12.058

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Late-Onset Kidney Biopsy-Associated Retroperitoneal Hemorrhage in Lupus Nephritis: A Case Report of Pseudoaneurysm and Microaneurysm Formations

Case Reports in Nephrology and Dialysis (2021)

Panupong Hansrivijit Kinjal P. Gadhiya Sandra D. Zelonis John Cinicola

Late-onset retroperitoneal hemorrhage from renal intraparenchymal pseudoaneurysm (RIP) following a kidney biopsy is an extremely rare complication but should not be ignored, especially in high-risk populations. Here, we introduce a 32-year-old Caucasian female who presented with sudden-onset left-sided flank pain. She had recently been diagnosed with systemic lupus erythematosus (SLE) and had undergone a computed tomography (CT)-guided core needle biopsy of the left kidney 9 days earlier. The results were consistent with lupus nephritis class III or IV. Initial vitals were within normal limits. She appeared pale and her left flank was tender to palpation without discoloration or abdominal distention. Laboratory investigations showed a hemoglobin level of 7.1 g/dL. The CT scan of the abdomen and pelvis revealed a large hyperdense left perinephric collection consistent with perinephric hematoma with a moderate amount of retroperitoneal stranding most prominent on the left side extending across the midline to the right side. Contrast extravasation was suspected in the lower pole of the left kidney consistent with active bleeding site. Emergent renal angiography revealed a 2 × 1 cm intraparenchymal pseudoaneurysm in the lower pole of the left kidney along with a few small microaneurysms. Coil embolization of the pseudoaneurysm was successfully performed without any complications. In conclusion, SLE or lupus nephritis in this patient may be the predisposing factors for microaneurysm and RIP formations. RIP is an unusual complication after percutaneous kidney biopsy that carries a significant mortality rate if ruptured, causing retroperitoneal hemorrhage. Clinicians should be vigilant when encountering high-risk patients with persistent hematuria, flank pain, or abdominal pain within four weeks after a kidney biopsy.

Pseudoaneurysm

Retroperitoneal space

10.1159/000512229

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A rare case of diabetic ketoacidosis presenting with severe hypertriglyceridemia requiring plasmapheresis in an adult with type-2 diabetes mellitus

Medicine (2021)

Pooja Roy Paige Koetter Jessica Cunningham Saketram Komanduri John Cinicola

Abstract Introduction: Severe hypertriglyceridemia (HTG) is a rare complication of insulin resistance. Its presentation with diabetic ketoacidosis (DKA) has been reported in a few cases, where most patients have type-1 diabetes mellitus (DM). Our case represents a unique presentation of DKA associated with severe HTG above 10,000 mg/dL in an adult with type-2 DM. Patient concerns and diagnosis: Case Report: A 51-year-old man with no prior illnesses presented to the emergency department with abdominal pain and nausea. He was found to have DKA with a blood glucose level of 337 mg/dL, pH of 7.17, beta-hydroxybutyrate of 7.93 mmol/L, and anion gap of 20 mmol/L. His triglyceride levels were >10,000 mg/dL. His serum was found to be lipemic. Computerized tomography scan of the abdomen demonstrated mild acute pancreatitis. Negative GAD65 antibodies supported the diagnosis of type-2 DM. Interventions and outcomes: Endocrinology was consulted and one cycle of albumin-bound plasmapheresis was administered. This therapy significantly improved his HTG. DKA gradually resolved with insulin therapy as well. He was discharged home with endocrinology follow-up. Conclusion: This unique case highlights an uncommon but critical consequence of uncontrolled DM. It brings forth the possibility of severe HTG presenting as a complication of uncontrolled type-2 DM. Severe HTG commonly presents with acute pancreatitis, which can be debilitating if not managed promptly. Most patients with this presentation are managed with insulin infusion. The use of plasmapheresis for management of severe HTG has not been well studied. Our case supports the use of plasmapheresis as an effective and rapid treatment for severe HTG.

Plasmapheresis

Diabetic ketoacidosis

Ketoacidosis

10.1097/md.0000000000026237

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Prognostic Scores and Survival Rates by Etiology of Hepatocellular Carcinoma: A Review

Journal of Clinical Medicine Research (2023)

Evelyn Calderon Martinez Samanta Landazuri-Navas Esmeralda Vilchez Raúl Cantú-Hernández Johanna Mosquera-Moscoso

Hepatocellular carcinoma (HCC) is a common cancer and ranks sixth among all malignancies worldwide. Risk factors for HCC can be classified as infectious or behavioral. Viral hepatitis and alcohol abuse are currently the most common risk factors for HCC; however, nonalcoholic liver disease is expected to become the most common cause of HCC in upcoming years. HCC survival rates vary according to the causative risk factors. As in any malignancy, staging is crucial in making therapeutic decisions. The selection of a specific score should be individualized according to patient characteristics. In this review, we summarize the current data on epidemiology, risk factors, prognostic scores, and survival in HCC. J Clin Med Res. 2023;15(4):200-207 doi: https://doi.org/10.14740/jocmr4902

Etiology

10.14740/jocmr4902

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Citations (35)