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Since granulomatous inflammation in sarcoidosis is CD4 T-helper lymphocyte mediated, in HIV patients sarcoidosis typically becomes manifest as a form of immune reconstitution inflammatory syndrome (IRIS). In a series of 11 HIV+ patients, sarcoidosis was discovered after ART-induced marked increases in the CD4 count and decreases in viral load. [Extracted from the article]

A 53-year-old woman with no significant past medical history came to her local ED after a witnessed generalized tonic-clonic seizure. CT scan imaging of the head revealed a left frontal lobe hypodensity concerning for a mass with surrounding edema. In the previous month, she had undergone ambulatory evaluation for a subacute cough that had more recently become productive of bloody sputum. Outpatient chest radiography had demonstrated a new right lung opacity, shown on subsequent CT scan imaging to be a right upper lobe (RUL) consolidation. She was prescribed a course of doxycycline, after which sputum expectoration improved but a nonproductive cough remained. Repeat thoracic imaging was pending at the time the seizure occurred. The patient had no history of chronic lung disease or recurrent infections. There were no constitutional symptoms. She did not take any home medications on a regular basis. She was a lifetime nontobacco user. She denied use of alcohol and illicit drugs. She had previously worked in a medical office but was now spending most of her time helping her husband take care of their house and property in Kingston, New York, a town of about 23,000 people in the Hudson River Valley. She was born in the United States and had not traveled recently. She had no pets. There was no history of recent dental procedures. She was transferred to our institution for neurosurgical evaluation. [ABSTRACT FROM AUTHOR]

An 80-year-old man presented because of superficial head trauma sustained after falling from bed. On review of systems, he reported worsening dyspnea on exertion, nonproductive cough, and weight loss over the preceding 2 to 3 months. There was no report of chest pain or leg swelling. He had a past medical history of hypertension, coronary artery disease, subclinical hypothyroidism, and renal cell carcinoma treated with partial right nephrectomy approximately 1 year before this presentation. Two months earlier he had been evaluated in the dermatology clinic for painful, dystrophic fingernails. At that time he was diagnosed with acropachy with onycholysis and suspected superinfection, and after failing to improve with vinegar soaks and topical antimicrobials, he underwent surgical nail removal on the second and fourth digits of the right hand. Histological examination of the operative specimens revealed dystrophic nails with negative fungal stains. His medications included levothyroxine, hydrochlorothiazide, and clopidogrel. He had never smoked and had done clerical work until retirement. He was originally from Colombia. [ABSTRACT FROM AUTHOR]

Of note, 5 patients (71%) had small pleural effusions prior to OHT, and there was a progression in 3 patients, showing evidence of concordance of effusion side pre-and post OLT. B CONCLUSIONS: b The majority of post-OHT patients at our institution had radiologically apparent pleural effusions during the post-OHT hospitalization, but only a very small minority underwent pleural fluid analysis. [Extracted from the article]

Among non-HIV PCP admissions, diagnosis of cancer was present in 54%, connective tissue disease in 9%, solid organ/stem cell transplant in 7%, and immune disorders in 5%. Among non-HIV PCP admissions, rates of other comorbid disorders increased between 2005 and 2014 (cancer 52% to 62%, connective tissue disease 8% to 14%, solid organ/stem cell transplant 7% to 8%, immune disorders 4% to 8%; Ptrend< 0.001). Overall mortality in patients with PCP was 12%, and was significantly higher with non-HIV PCP (21%) than with HIV-PCP (9%; P< 0.001). [Extracted from the article]

Among patients with liver cirrhosis prior to liver transplantation, CO production as measured by blood carboxyhemoglobin (COHb) levels were noted to be even higher in patients with Hepato-pulmonary syndrome (HPS) compared to those who has not. Among patients without HPS, the mean COHb levels prior to transplant was 2.5% which decreased to 1.95% (p=0.0003) after transplant with mean delta change of 0.55. After liver transplant, COHb levels significantly decreased in all patients but much more so in patients with HPS compared to without HPS as shown by the substantial difference in delta change. [Extracted from the article]

A 66-year-old woman presented with acute onset of fever, chills, and productive cough associated with right-sided chest pain. During a recent hospitalization for dyspnea, she had been diagnosed with Coombs-positive autoimmune hemolytic anemia and had been taking a tapering dose of prednisone starting approximately 6 weeks prior to admission. In the interim, her dyspnea had resolved on treatment with steroids. At the time of presentation, her prednisone dose was 40 mg. Additional medical history included VTE, for which the patient was receiving anticoagulation therapy, and steroid-induced diabetes mellitus. Many years earlier, she had been treated for TB in her home country. The patient had immigrated to Queens, New York, from a Nepalese village 8 years prior. While still in Nepal, she had worked on a farm and had been in close proximity to cows. In Queens, she lived with her family in a house with a small garden but had no pets. Recent travel included a visit to Nepal 9 months ago and a trip to Syracuse, New York, one month prior to presentation. She was a never smoker and did not consume alcohol. [ABSTRACT FROM AUTHOR]

A 47-year-old man with no significant past medical history, originally from Indonesia, was brought to the ED of an urban US medical center after being found collapsed on the sidewalk in respiratory distress and with an altered sensorium. Upon arrival to the ED, he was tachypneic, with increased work of breathing and an oxygen saturation of 88% on 100% nonrebreather mask, so he was immediately intubated. Following intubation, he became profoundly hypotensive, requiring aggressive crystalloid resuscitation and vasopressor support. Broad-spectrum antimicrobials were administered, including ceftriaxone, vancomycin, levofloxacin, and oseltamivir. Further history elicited subsequently from family members revealed that the patient had returned from a 2-week vacation in Indonesia 6 days prior to presentation. According to relatives, he appeared to be in his usual state of health upon his return and was not seen by anyone thereafter, but in the interim he reportedly had an episode of epistaxis, and text messages received from him became progressively more bizarre. [ABSTRACT FROM AUTHOR]