Hot Dab Associated Pneumonitis - a case report.

BACKGROUND: Dabbing is recently getting popular among young adults. It is a new method of using the most active form of marijuana where large amounts of concentrated tetrahydrocannabinol are inhaled. Tetrahydrocannabinol is associated with a feeling of 'High' which makes the user feel joyous and relaxed. With increasing use of such techniques, dabbing becomes an important differential for evaluation of acute respiratory failure with pneumonitis especially in the adult population. CASE PRESENTATION: A Fifty-one years old Caucasian man presented to the hospital with chest pressure and shortness of breath. The patient was noted to be hypoxic, desaturating down to 82-83% on nasal cannula oxygen. Imaging revealed bilateral lung infiltrates. Patient was started on high flow oxygen, broad spectrum antibiotics and intravenous corticosteroids. The patient gradually improved and was able to come off oxygen completely. He was discharged home on prednisone taper. CONCLUSIONS: Dabbing is a newer technique which has been gaining popularity for marijuana usage. With the legalization of marijuana, newer techniques are getting popular. Our case report emphasizes the importance of keeping dabbing as a differential when a patient presents with respiratory failure and has concerns for pneumonitis. Patients might not reveal until specifically asked about their practices.

Flushing: A Diagnostic Dilemma.

Carcinoid tumors are uncommon tumors that are often diagnosed in later stages of the disease due to their indolent nature, vague clinical presentation and overlap of symptoms with other conditions. We report a case of rectosigmoid carcinoid tumor which was found incidentally on screening colonoscopy in an elderly woman that went undiagnosed for several years due to confounding effects of symptoms of post-hysterectomy menopause with that of carcinoid syndrome. Persistent episodic flushing with or without diarrhea not resolved with standard treatment should lead to suspicion of neuroendocrine tumors (NETs). This case report emphasizes the need to broaden our perspective of menopausal symptoms and pay attention to the characteristic clinical symptoms of NETs.

Disseminated Histoplasmosis in an Adult With Rheumatoid Arthritis Not on Biological Immune Modulators.

Histoplasmosis is a fungal disease caused by a dimorphic fungus known as Histoplasma capsulatum (H. capsulatum), which is endemic to areas around river valleys and southeastern states in the United States (US). Patients with histoplasmosis are asymptomatic, and the condition is usually diagnosed by an incidental finding of a pulmonary granuloma on a chest radiograph. In rare cases, this disease can develop into a progressive disseminated form and cause fatal and diffuse pulmonary infiltrates in immunocompromised adults. Moreover, there is a close association between disseminated histoplasmosis and the use of tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA). Our case report discusses a unique presentation of disseminated histoplasmosis in a patient with RA who was not on any biological immune modulators. The disseminated histoplasmosis in this case was progressive and involved the central nervous system, liver, lungs, and oral mucosa and was treated successfully with amphotericin therapy. We also discuss the disease process in detail and hypothesize that RA could be an independent risk factor for the increased incidence of disseminated histoplasmosis in adults. Based on the findings in this case report, we recommend screening for latent Histoplasma infections in adults with RA living in endemic areas and keeping a low threshold to evaluate flare-ups from this disease regardless of the use of anti-TNF inhibitors. Specific experimental and epidemiological studies can be conducted to examine the association between RA and similar indolent fungal infections.

Autoimmune atrophic gastritis in systemic sclerosis.

Systemic sclerosis (SSc) is a rare connective tissue disorder with a complex pathogenesis involving vascular dysfunction, small vessel proliferation as well as alterations of innate and adaptive immunity. Gastrointestinal (GI) involvement in SSc is almost universal and affects nearly 90% of the patients. Of all the GI manifestations, 30%-75% are oesophageal abnormalities, including gastro-oesophageal reflux disease, reflux oesophagitis and Barret's oesophagus. The incidence of gastric manifestations is about 22% with a common presentation of gastric antral vascular ectasia (GAVE). However, autoimmune atrophic gastritis (AIG) is not a known manifestation of SSc. Our case has a unique presentation of the coexistence of GAVE and AIG. We have conducted a thorough literature review to study a possible association of AIG and SSc and understand the pathology of SSc.

Clinical characteristics and outcomes of patients with Corona Virus Disease 2019 (COVID-19) at Mercy Health Hospitals, Toledo, Ohio.

IMPORTANCE: The ongoing pandemic of the novel Corona Virus Disease 2019 (COVID-19) is an unprecedented challenge to global health, never experienced before. OBJECTIVE: This study aims to describe the clinical characteristics and outcomes of patients with COVID-19 admitted to Mercy Hospitals. DESIGN AND METHODS: Retrospective, observational cohort study designed to include every COVID-19 subject aged 18 years or older admitted to Mercy Saint (St) Vincent, Mercy St Charles, and Mercy St Anne's hospital in Toledo, Ohio from January 1, 2020 through June 15th, 2020. Primary Outcome Measure was mortality in the emergency department or as an in-patient. RESULTS: 470 subjects including 224 males and 246 females met the inclusion criteria for the study. Subjects with the following characteristics had higher odds (OR) of death: Older age [OR 8.3 (95% CI 1.1-63.1, p = 0.04)] for subjects age 70 or more compared to subjects age 18-29); Hypertension [OR 3.6 (95% CI 1.6-7.8, p = 0.001)]; Diabetes [OR 3.1 (95% CI 1.7-5.6, p<0.001)]; COPD [OR 3.4 (95% CI 1.8-6.3, p<0.001)] and CKD stage 2 or greater [OR 2.5 (95% CI 1.3-4.9, p = 0.006)]. Combining all age groups, subjects with hypertension had significantly greater odds of the following adverse outcomes: requiring hospital admission (OR 2.2, 95% CI 1.4-3.4, p<0.001); needing respiratory support in 24 hours (OR 2.5, 95% CI: 1.7-3.7, p<0.001); ICU admission (OR 2.7, 95% CI 1.7-4.4, p<0.001); and death (OR 3.6, 95% CI 1.6-7.8, p = 0.001). Hypertension was not associated with needing vent in 24 hours (p = 0.07). CONCLUSION: Age and hypertension were associated with significant comorbidity and mortality in Covid-19 Positive patients. Furthermore, people who were older than 70, and had hypertension, diabetes, COPD, or CKD had higher odds of dying from the disease as compared to patients who hadn't. Subjects with hypertension also had significantly greater odds of other adverse outcomes.