Muhammad Atique Alam Khan

St. Joseph Medical Center in Tacoma

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Iqra Iqbal

Mercy Hospital

Waqas Ullah

Jefferson Hospital

Artem Minalyan

Loma Linda University

Jonathan Slusser

Jefferson Hospital

Mohsin Hamid

Conemaugh Memorial Medical Center

Maryam Mukhtar

University Hospitals of Leicester NHS Trust

Puneet Dhillon

Cleveland Clinic

Shafaq Tariq

University of Arizona

Shujaul Haq

Thomas Jefferson University Hospital

Nishanth Thalambedu

University of Arkansas for Medical Sciences

Cooperative Institutions

Abington Memorial Hospital

Thomas Jefferson University Hospital

Jefferson Hospital

King Edward Medical University

Thomas Jefferson University

Jefferson University Hospitals

Philadelphia College of Osteopathic Medicine

Detroit Medical Center

Drexel University

Temple University

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Sudden death due to pulmonary embolism after minor ankle surgery

BMJ Case Reports (2019)

Maryam Mukhtar Mohsin Hamid Muhammad Atique Alam Khan Waqas Ullah

Venous thromboembolism prophylaxis guidelines are clear for major orthopaedic surgeries, but data regarding ankle surgery are insufficient. Death from pulmonary embolism (PE) after ankle surgery is rare with the frequency of less than 0.037%. 1 We present a case of a fatal PE after ankle surgery to raise awareness about this rare but potentially fatal complication. Our patient had a left ankle fracture status postsurgical fixation and was discharged without venous thromboembolism (VTE) prophylaxis. Twenty days later, she presented with a sudden onset of dyspnoea and palpitations and was diagnosed to have extensive right-sided PE. Intravenous heparin and thrombolytics were given, but she had multiple pulseless electrical activity arrests, developed disseminated intravascular coagulation and died. Our case depicts an unusual complication of ankle surgery and highlights the importance of considering VTE as one of the complications. Medical personnel should evaluate the need for VTE prophylaxis after ankle surgery on a case to case basis.

Palpitations

10.1136/bcr-2018-227649

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Citations (2)

181: Convalescent Plasma Therapy in a Refractory Case of COVID-19 in an Immunocompromised Patient

Critical Care Medicine (2020)

Stephanie Tzarnas Mackenzie Kramer Nicolette Alberti Vincent Chan Muhammad Atique Alam Khan

Tzarnas, Stephanie; Kramer, Mackenzie; Alberti, Nicolette; Chan, Vincent; Khan, Muhammad Atique Alam; Madara, John Author Information

Convalescent plasma

Refractory (planetary science)

2019-20 coronavirus outbreak

10.1097/01.ccm.0000726612.71471.eb

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A Case of Fibroelastoma with Widespread Embolism to the Brain, Kidney, and Spleen

Cureus (2019)

Iqra Iqbal Waqas Ullah Muhammad Atique Alam Khan Shujaul Haq Arslan Cheema

Cardiac papillary fibroelastoma (CPF) is the second most common primary cardiac tumor, which is diagnosed incidentally or with embolic phenomena, mostly in the form of a transient ischemic attack (TIA) and stroke. We present a case of a 58-year-old female who presented with fatigue and low-grade fever and was found to have multiple systemic infarcts. Her blood cultures and transthoracic echocardiography (TTE) were negative, ruling out infective endocarditis. However, transesophageal echocardiography (TEE) revealed a mobile mass at the aortic valve. The mass was surgically removed, and the aortic valve was repaired. The histological examination of the mass finally revealed a papillary fibroelastoma. To our knowledge, this is the first reported case where fibroelastoma presented with splenic and renal infarcts in combination with the cerebral infarcts. Since cardiac fibroelastoma can cause embolization to the cerebral, splenic, and renal vessels, we, therefore, advocate that it should be considered as one of the possible causes of widespread embolism. We also stress upon the importance of doing TEE in case of a suspected cardiac mass, as the TTE is more likely to give false-negative results.

Papillary fibroelastoma

Stroke

Infective Endocarditis

Transesophageal echocardiogram

10.7759/cureus.4798

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SUN-520 Graves Disease and T3 Thyrotoxicosis: A Case Report

Journal of the Endocrine Society (2020)

Nishanth Thalambedu Iqra Iqbal Shristi Khanal Muhammad Atique Alam Khan

Abstract Introduction: Hyperthyroidism is one of the common problems in the world of endocrinology. Identifying the type of thyrotoxicosis is crucial before starting treatment. We present a case of a 37-year-old woman presented with hyperthyroidism and was started on methimazole. Her symptoms persisted and further workup showed T3 thyrotoxicosis. Her symptoms improved after switching her to PTU. She eventually underwent thyroidectomy. Case description: Thirty-seven-year old African American woman presented to her primary care physician(PCP) with symptoms suggestive of hyperthyroidism for three months. Her past medical history is significant for recent delivery one year ago. Her Physical exam is pertinent for hypertension of 160/80 with a heart rate of 120. Her neck is diffusely enlarged with bilateral bruits. Bilateral lid retraction with lid lag was noted along with left lid proptosis. There were no tremors or leg swelling noted. Her Initial workup showed sinus tachycardia in the electrocardiogram. Her TSH level was <0.010 and a free T4 level of 3.48. Ultrasound showed diffuse enlargement of the thyroid gland with no focal nodule. She was started on methimazole 10mg twice daily and metoprolol 25mg twice daily. Three months later, she presented to the emergency room(ER) with tachycardia of 130 and hypertension of 170/85. Work up showed a TSH level of <0.010 and a free T4 level of 3.94. She was compliant with medications. When free T3 levels were checked it turned out to be >30. She was diagnosed with T3 Thyrotoxicosis and was started on propylthiouracil 150mg every 8 hours. Her metoprolol was increased to 50mg every 12 hours. Her symptoms improved and she finally underwent surgery for thyroidectomy. Discussion: Hyperthyroidism is seen in about 1 in 5000 with a strong female predominance. Graves disease, the most common cause of hyperthyroidism is due to excess production of TSH receptor stimulating antibodies. Hyperthyroid patients with graves disease sometimes have a disproportionate increase in serum T3 levels when compared to serum T4. This is thought to be due to increased T3 production or extrathyroidal conversion of T4 to T3. It is very crucial to identify the free hormone levels in a new patient with hyperthyroidism because of the difference in management. Antithyroid drugs are traditionally the first-line treatment option along with beta-blockers prior to definitive therapy like radioactive iodine or thyroidectomy. The main drugs used are methimazole and propylthiouracil(PTU). Methimazole is more commonly used than PTU because of its rapid efficacy, longer duration of action and less adverse effects. For patients with T3 thyrotoxicosis, PTU is preferred as it is known to reduce the peripheral conversion of T4 to T3. Our patient medication was changed from methimazole to PTU, after which she started to notice improvement. She eventually underwent definitive treatment with thyroidectomy.

Sinus tachycardia

10.1210/jendso/bvaa046.1905

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Abstract #995863: “How Do You Inject insulin?”: A Mysterious Case of Chronic Painful Skin Lumps

Endocrine Practice (2021)

Artem Minalyan Iqra Iqbal Muhammad Atique Alam Khan Franklin Thelmo Jonathan Slusser

Lipoatrophy

10.1016/j.eprac.2021.04.538

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Can inhaled heroin be a cause of bilateral globus pallidus ischemic injury?

Turkish Journal of Emergency Medicine (2018)

Iqra Iqbal Muhammad Atique Alam Khan Waqas Ullah

Bilateral globus pallidus lesions have been characteristically thought to be associated with global cerebral hypoperfusion and hypoxic changes. One of the important causative factors that need to be considered is the opiate drug abuse.We present a case of a 50-year-old male who came to the hospital after being found down for 3 hours. He was found to have weakness of right upper and lower extremity. MRI showed bilateral globus pallidus infarcts. He later admitted to inhalation of heroin. Over the next few days, weakness started to improve and he was eventually discharged to rehabilitation. This case is a unique presentation of bilateral globus pallidus lesions after a one-time inhalation of heroin.We, therefore, advocate that inhaled heroin should be considered as one of the causes of bilateral globus pallidus lesions, in addition to IV heroin and cocaine and physicians should be aware of the possibility of alternate forms of heroin abuse in such patients.

10.1016/j.tjem.2018.11.001

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Hypercalcemia Due to Paraneoplastic Production of 1,25- Dihydroxyvitamin D in a Young Female with Dysgerminoma

Cureus (2019)

Iqra Iqbal Muhammad Atique Alam Khan Yasir Khan Nishanth Thalambedu Samavia Munir

Humoral hypercalcemia of malignancy (HHM) can be caused by ectopic paraneoplastic production of 1, 25 dihydroxy vitamin D due to the hyperactivity of the 1 alpha-hydroxylase enzyme. We present a case of a 19-year-old female who was admitted with bilateral dysgerminomas and significant hypercalcemia. Hypercalcemia was initially managed medically and then resolved with the surgical resection of the tumors. Although most cases are attributed to a high parathyroid hormone-related peptide (PTHrP) and bone metastases, <1% of cases can result from paraneoplastic production of 1,25 dihydroxyvitamin D due to increased activity of 1 alpha-hydroxylase.This is one of the rare cases of hypercalcemia, which not only adds to the limited number of cases of hypercalcemia associated with dysgerminoma but also is the first case report showing that vitamin D can be a paraneoplastic factor itself.

Dysgerminoma

10.7759/cureus.6097

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THU383 “My Hands Are Always Stiff”: A Common But Underrecognized Mimicker Of Inflammatory Arthritis.

Journal of the Endocrine Society (2023)

Iqra Iqbal Artem Minalyan Muhammad Atique Alam Khan

Abstract Disclosure: I. Iqbal: None. A. Minalyan: None. M. Khan: None. Introduction: Inflammatory arthropathies are often identified in patients by their characteristic patterns, including symmetric small joint involvement, joint stiffness that can improve with physical activity, and others. However, it is crucial to address comorbidities and their impact on symptom presentation when assessing these patients. Here we present a case of a relatively common but underrecognized mimicker of inflammatory arthropathies. Case: A 63-year-old man with Type 1 Diabetes Mellitus (DM1) and seronegative rheumatoid arthritis (RA) was referred to a rheumatology clinic by his family physician to manage RA. He was previously treated with prednisone and methotrexate for six months for presumed seronegative rheumatoid arthritis without any relief. He reported chronic pain and stiffness in his joints: wrists, metacarpophalangeal (MCP), proximal and distal interphalangeal (PIP and DIP) joints, ankles, and feet. His symptoms were worse in the morning. However, on further questioning, he admitted that the stiffness did not improve throughout the day. He denied joint swelling or redness over the affected joints. On exam, his hand joints had significant stiffness. We obtained hand radiographs which did not show erosive changes or significant joint space narrowing. He had negative rheumatoid factor (RF), normal anti-cyclic citrullinated peptide (CCP) antibodies, and antinuclear antibody (ANA) levels, which ruled out the diagnosis of rheumatoid arthritis. A detailed physical exam demonstrated a positive “prayer sign” and “tabletop sign.” Further lab review showed that his hemoglobin A1c (HbA1C) had been ranging between 8% to 10% over several years. Eventually, the patient was diagnosed with limited joint mobility due to the poorly controlled DM1. We discontinued his methotrexate and referred him to an endocrinologist to manage the uncontrolled DM1. He was referred to physical therapy for hand stretching exercises. After six months of treatment, his symptoms improved but did not resolve completely. Conclusion: It is essential to identify the impact of diabetes on the musculoskeletal system. Limited joint mobility, previously known as diabetic cheiroarthropathy (DCA), is a common but frequently missed manifestation of poorly controlled diabetes. It is characterized by a limited ability to flex or extend the MCP and IP joints. It may or may not be painful and can progress to fixed flexion contractures of the finger joints. Early recognition is essential for correct diagnosis. Treatment is with tighter glycemic control and physical therapy. Presentation: Thursday, June 15, 2023

Rheumatoid factor

Interphalangeal Joint

Inflammatory arthritis

10.1210/jendso/bvad114.816

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Abstract #986678: Internal Medicine Residents' Knowledge about Insulin

Endocrine Practice (2021)

Iqra Iqbal Artem Minalyan Muhammad Atique Alam Khan Shristi Khanal Jonathan Slusser

Blood sugar

Diabetes management

10.1016/j.eprac.2021.04.529

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An Interesting Case of Isolated Bone Marrow Sarcoidosis

Journal of the Endocrine Society (2021)

Iqra Iqbal Artem Minalyan Muhammad Atique Alam Khan Glenn A. McGrath

Abstract Introduction: About 30% cases of sarcoidosis have extrapulmonary manifestations but only 7% of patients present without any lung involvement. Among those 7%, most of the patients have manifestations on the skin but isolated bone marrow sarcoidosis has not been commonly reported. This case represents an unusual manifestation of isolated bone marrow sarcoidosis presenting with very high calcium levels. Case Presentation: A 58-year-old female presented to us with fatigue, poor appetite, and nausea. She did not report any weight changes. Her cancer screening was up to date. On examination, she appeared dehydrated. No neck swelling was appreciated. Cardiac, respiratory, abdominal, and neurological examinations were normal. Complete blood count showed hemoglobin of 10.6 mg/dL, white blood cell count of 3.8 k/dL, and platelet count of 87 x109/L. Metabolic panel revealed hypercalcemia with corrected calcium levels as high as 12.6 mg/dL. Ionized calcium was 8.1 mg/dL (normal 4.8 - 5.6). Her parathyroid hormone (PTH) level was elevated up to 64.6 mg/dL and then further increased to 134.3 mg/dL. A 24-hour urinary calcium level was normal. 1, 25-dihydroxy (1,25-OH) and 25-OH vitamin D levels were 97 mg/dL (normal 18–72) and 31.2 mg/dL, respectively. Serum protein electrophoresis and light chain analysis were normal. Hyperparathyroidism was suggested as a cause of hypercalcemia. Ultrasound of the neck and sestamibi scan showed a right lower pole parathyroid adenoma. Paraneoplastic hypercalcemia was also one of the differentials. Parathyroid hormone related peptide (PTHrP) was 9 pg/mL (normal 14 - 27). Colonoscopy was normal. Computerized tomography showed normal lungs, liver and spleen. No masses and lymphadenopathy was seen. A bone marrow biopsy was done for pancytopenia. Patient underwent parathyroid adenoma removal followed by a drop in serum calcium level (8.2 mg/dL). Patient was discharged on calcium carbonate and vitamin D tablets. Upon outpatient follow-up, calcium level started to rise again up to 9.8 mg/dL. Despite discontinuation of supplemental calcium and vitamin D, calcium continued to uptrend (11.5 mg/dL 4 weeks later). Angiotensin converting enzyme (ACE) level came back as high as 129 (normal level < 40 mcg/L). Meanwhile, the bone marrow biopsy results showed that 40% of bone marrow was occupied by non-caseating granulomas suggesting sarcoidosis. Patient was started on steroids for isolated bone marrow sarcoidosis, and eventually her serum calcium level normalized. Conclusion: An isolated bone marrow sarcoidosis is an extremely rare manifestation of extrapulmonary sarcoidosis. It can present with pancytopenia and should be sought in patients with persistent hypercalcemia. In addition, our case was challenging due to the presence of a concurrent hyperparathyroidism which was initially thought to be the only explanation of our patient’s hypercalcemia.

10.1210/jendso/bvab048.364

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