Microbiology / Infectious Disease
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21660
Browse
Browsing Microbiology / Infectious Disease by Author "Liu, Luna"
Now showing 1 - 2 of 2
- Results Per Page
- Sort Options
Item Histoplasmosis Mistaken for Lung Neoplasm During Immunosuppression Therapy(2018-03-14) Liu, Luna; Sisay, Emnat; Machaiah, Madhrira; Bohra, HemaBackground TNFα antagonists such as Cimzia use large immunogenic protein molecules to induce deviations in normal host immunity and inflammatory response. Most warnings address alert providers to seriously consider initiating immunologics, because TNF plays an important role in immunity, notably against mycobacteria. Cimzia is different than other prior agents targeting TNF, because it does not fix, complement or induce cell-mediated cytotoxicity that is antibody-dependent from not having an immunologic Fc portion. Case information A sixty year-old female with psoriasis, hypertension and greater than fifteen year history of Crohn's disease on Cimzia presented after four months of cough, night sweats, weight loss and generalized weakness. Her productive chronic cough evolved from brownish and bloody phlegm to a greenish color. Initial imaging from her PCP revealed a right upper lung mass thought to be a malignant tumor. Social history did not endorse any use of tobacco products or prior history of COPD, asthma or pneumonia. Family history for cancer was unremarkable. Patient describes that she was a teacher for many years in an older school building that had multiple past infestations, including possum. The initial attempt at bronchoscopy was inadequate for pathology, but repeated procedure denoted an exophytic and fungating mass. Cardiothoracic surgery performed an elective right partial right pneumonectomy and mediastinoscopy. Pathology performed on brushings were negative for malignancy, but endorsed a granuloma with acute inflammation. Final biopsy from the procedure revealed a granulomatous inflammation with a methenamine silver stain revealing histoplasmosis. Urine histoplasma antigen was negative, but antibody was high at 1:1, which can be seen with disseminated or diffuse pulmonary histoplasmosis. Patient began a short inpatient course of liposomal Amphotericin B transitioning to oral itraconazole prior to discharge. Conclusions Histoplasmosis mimics many common respiratory infections and neoplastic processes with symptom presentation and radiologic findings that have led to surgical resections of non-malignant pulmonary granulomatous nodules initially thought to be carcinomas. Patients on certolizumab should be closely monitored for the development of disseminated disease such histoplasmosis and warned about participating in activities that can expose them to inhalation of airborne microconidia.Item When Pigs Fly: Thromboembolic Events in a Case of Severe H1N1 Influenza Type A(2018-03-14) Moran, Robyn; Cota, Donna; Boehme, Matthew; Liu, LunaTitle: When Pigs Fly: Thromboembolic Events in a Case of Severe H1N1 Influenza Type A First Authors: Luna Liu, DO Co-Authors: Robyn Moran DO; Matthew Boehme, DO Attending: Donna Cota, DO; Mohan Sengodan, MD; Ranjit Nair, MD; Anupama Chennupati, MD; Background/Abstract: H1N1 Subtype Influenza Type A, the strain responsible for the 2009 pandemic, is primary regarded as a disease affecting lung parenchyma, yet it is its ability to infiltrate and cause system wide complications which has made it such a deadly virus1-2. It is hypothesize the disease process may cause a propensity for thromboembolic events through activation of platelets, alterations of coagulation factors, or endothelial dysfunction3. There have been multiple documented cases of pulmonary embolism and myocardial infarctions in prior reports in H1N1 infected individuals, but few of cerebral events4-6. We present a unique case of severe H1N1-influenza in a previously healthy 47 year old male whose hospital course was complicated by multiple cerebral infarcts and R-femoral DVT. Case Report: 47 year old caucasian male without a significant PMHx presented initially for fevers, myalgias, and respiratory distress requiring intubation at an outside facility. His condition worsened and was transferred to our facility for higher level of care. He was initially found to to have septic shock requiring pressor support and started on empiric antibiotics. On arrival, the pt also underwent a bronchoscopy with washings; multiple cultures of blood, bronchial washings, sputum were negative for any growth. The pt continue to have breakthrough fevers. On admission day 4, he was found to have a DVT of R-femoral vein and started on a heparin drip; of note, the pt had been on chemical DVT prophylaxis since admission. Pt had difficulty with arousability off sedation and underwent extensive work-up including CSF studies which were negative. An MRI was significant for multiple small bilateral cerebral infarcts. Repeat transthoracic echoes were negative for signs of endocarditis or PFO on bubble study. Pt improved following tracheostomy placement and was discharged to LTAC on day 17th of hospitalization. Discussion: This case serves to illustrate the widespread effects of Influenza Type A H1N1 Subtype, even in healthy individuals. In this particular case, the pt had both venous and arterial thromboembolic events which is unique. It is important to keep in mind the extent of the disease process in this disease, especially in critically-ill patients. References: Dimitroulis, I. A., Katsaras, M., & Toumbis, M. (2016). H1N1 infection and embolic events: A multifaceted disease. Pneumon, 29(3), 230-235. Coorevits, L., Demuynck, H., Boone, E., Roelens, J., & Surmont, I. (2011). Trombo-embolic complications in influenza A(H1N1)2009: A forgotten and fatal danger, also in so-called "mild" flu? [Trombo-embolische verwikkelingen bij influenza A(H1N1)2009: Een vergeten en fataal gevaar, ook bij "milde" griep?] Tijdschrift Voor Geneeskunde, 67(7), 337-339. 10.2143/TVG.67.07.2000941 Paul E. Bunce, Sasha M. High, Maral Nadjafi, Katherine Stanley, W. Conrad Liles, Michael D. Christian; Pandemic H1N1 Influenza Infection and Vascular Thrombosis, Clinical Infectious Diseases, Volume 52, Issue 2, 15 January 2011, Pages e14–e17, https://doi.org/10.1093/cid/ciq125 Avnon, L. S., Munteanu, D., Smoliakov, A., Jotkowitz, A., & Barski, L. (2015). Thromboembolic events in patients with severe pandemic influenza A/H1N1. Eur J Intern Med, 26(8), 596-598. doi:10.1016/j.ejim.2015.08.017 Chandra, M., & Chander, T. (2016). Uncommon presentation of H1N1-Bilateral pulmonary thrombo-embolism. J Assoc Physicians India, 64(1), 145. Tsujii, N., Nogami, K., Yoshizawa, H., Hayakawa, M., Isonishi, A., Matsumoto, M., & Shima, M. (2016). Influenza-associated thrombotic microangiopathy with unbalanced von Willebrand factor and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 levels in a heterozygous protein S-deficient boy. Pediatr Int, 58(9), 926-929. doi:10.1111/ped.13014