Clinical Pathology Conference 9/14/07

September 11, 2007

Bellevue AmphitheaterCase presentation by Danise Schiliro-Chuang MD, Chief Resident

Welcome to the monthly posting of our NYU Department of Medicine’s Clinical Pathology Conference. Use the links below to review the case and the radiological findings. Our faculty and medical students will be attempting to diagnose this unknown case Friday 9/14/07 in the 17 West Conference Room at Bellevue Hospital. Feel free to make your diagnosis by clicking the comment field below. For those who are unable to attend the live conference, we will reveal the answer next week.

CPC 9/14/07

CPC Powerpoint 9/4/107

One Response to Clinical Pathology Conference 9/14/07

  1. Cyrus Shariat on September 13, 2007 at 4:23 pm

    Before the labs and imaging, my ddx for this 70 y/o with subacute myalgias/weakness, fever and anemia included polymyalgia rheumatica, SLE, endocarditis, dermatomysosis, inclusion body myositis and malignancy associated with a paraneoplastic syndrome. The time course is probably too long for a viral myositis.

    With the additional data of renal failure, proteinuria/hematuria, + ANA, and Chest CT findings (rt. pleural thickening +/- cavitation, ground glass and interstial changes), SLE is highest on my ddx with culture negative endocarditis coming second.

    Culture negative IE could present like this but I haven’t heard of weakness (though it could be weakness secondary to disuse). I think that IE can also cause a false positive RF. Also, the rt. lung base finding on CT may be a septic embolus.

    He is not the typical demographic for SLE. However, he displays multiple findings of SLE including systemic signs/sx, mylagias, anemia, ANA positivity, possible nephritis and pleuralpulmonary involvement.

    I would start with repeat blood cultures and an echo to r/o culture negative IE. I would also check more specific autoimmune serologies including dsDNA, anti-Smith Ab, C3/C4, and have a nephrologist look at the urine for RBC casts or dysmorphic RBCs. If he has active urinary sediment, and a negative workup for endocarditis, I would do a renal biopsy. Alternatively, I would consider get CT guided pleural biopsy.

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