Rhabdomyolysis in the Setting of Severe Hyponatremia: A Case Report.

Electrolyte imbalances are common problems among hospitalized patients, and they can have severe consequences. Although rare, severe hyponatremia or low sodium (Na) levels have been associated with the occurrence of rhabdomyolysis. This is a case of a 45-year-old man who presented with confusion and lethargy and was found to have severe hyponatremia with an elevated creatine phosphokinase (CPK) level of 45,440 IU/L. With the administration of normal saline, the Na levels and CPK improved. He was discharged from the hospital in stable clinical condition. This case demonstrates the need for providers to monitor rhabdomyolysis markers in severe hyponatremia, as there is an observed association between the two and the sequelae can be severe.

A rare adverse event of atorvastatin inducing leukocytoclastic vasculitis with ANCA-negative (Anti-Neutrophil cytoplasmic antibody) case report and literature review.

Leukocytoclastic vasculitis is an entity associated with drugs, infections, cryoglobulinemia, and connective tissue diseases but can also be idiopathic, systemic, or organ localized. Moreover, LCV associated with drugs is a rare disorder. When it is present usually has an elevation of anti-neutrophil cytoplasmic antibody, most likely anti-myeloperoxidase, which can be helpful to orient the diagnosis. We are presenting a 55-year-old female with a past medical history of diabetes mellitus (DM) and hyperlipidemia (HLD) who presented with a painful and pruritic rash localized in the abdomen and lower extremities that started 1 week after initiated atorvastatin for management of hyperlipidemia. This is the first case ever reported of leukocytoclastic vasculitis ANCA negative associated with atorvastatin, to our best knowledge.

Experiences of race- and gender-based discrimination among Black female physicians.

INTRODUCTION: Recently, in the United States, there has been a strong effort to increase representation of members of social groups underrepresented in medicine (URiM). Experiences of discrimination among URiM group members, including women and people of color, have negative effects on their health and well-being and drive further underrepresentation. Here we report results of a qualitative research study designed to characterize Black female physicians' experiences of discrimination related to their identities both as women and people of color, in medical education and the practice of medicine. METHODS: A trained interviewer conducted semi-structured qualitative, in-depth interviews with twenty Black, cis-gender, female physicians working in various fields of medicine. Broadly framed within intersectionality theory and analyzed using a pragmatic analytic approach, all interviews were transcribed, read, coded, and analyzed identifying key emergent themes. RESULTS: Two broad and overlapping themes emerged: (1) experiencing and managing micro/macroaggressions and biases in the workplace; and (2) strategies to overcome experiences of intersectional discrimination. Each theme contained several subthemes, such as "presumed incompetence", "isolation and exclusion", "managing burdensome expectations", "building support systems", "speaking up", and "resilience". Participants described both intersectional and independent forms of discrimination and a range of sources of discrimination, including patients, peers, and colleagues, in their careers as trainees and professionals. Most described minimal and largely ineffective efforts to prevent or mitigate the impact of discrimination at any level of their educational and professional contexts. DISCUSSION: Black female physicians report experiencing damaging discrimination with few effective intervention efforts in tAheir medical training and workplaces. There is need for more research and evaluation of interventions to reduce discrimination at all levels of education and training.

Acute Generalized Exanthematous Pustulosis in a Setting of Cutaneous Lymphoma.

Acute generalized exanthematous pustulosis (AGEP) is a rare dermatological manifestation of the adverse drug reaction that occurs for a varied duration after the receipt of certain drugs. It manifests as an acute onset of generalized exanthematous pustular reaction with an edematous base. It has a characteristic clinical presentation and rapid resolution soon after the removal of the offending drug. The unique histological finding is that of single-cell necrosis of keratinocytes with edema of papillary dermis accompanied by components of vasculitis and/or exocytosis of eosinophils. Management consists of moist antiseptic dressings, topical steroids, infliximab, the use of systemic steroids if needed, and avoiding antibiotics as much as possible. Here, we present a case of AGEP in a setting of usages of antibiotics like vancomycin, cefepime, and ceftriaxone in a patient with cutaneous lymphoma that resolved after withdrawal of the offending antibiotics.