Medicine Grand Rounds: 'Hospital Medicine CPC' November 15, 2022

Speakers and CME Information:

Speakers:
Patricia Hwang, MD- HMS Presenter
Assistant Professor of Medicine
Division of Hospital Medicine
Emory University School of Medicine

Yelena Burklin, MD- MHS Discussant
Associate Professor of Medicine
Division of Hospital Medicine
Emory University School of Medicine

Shahzeena Hafeez, MD- Endo Consultant
Assistant Professor of Medicine
Division of Endocrinology, Metabolism, and Lipids
Emory University School of Medicine

Eli Wilber, MD- ID Consultant
Infectious Disease Fellow
Emory University School of Medicine

[vadimnobel]

Great catch/case. I wonder what led the the cortisol level testing in the first place? Not very clear from the case presentation, or maybe I missed? Was it just the lowish blood pressure? The hypokalemia can be a confounding factor. Up until the BM bx, I was leaning towards some myeloproliferative disorder.

[justinesportsmedicine]

Beautiful case presentation, workup, and discussion. Unfortunately, patients with substance abuse in this stage usually present with a multitude of symptoms all calling for thorough workup as completed here and the urgent need for rapid workup before these patients leave AMA. I didn't see if with negative HIV & cancer w/u whether her prealbumin/albumin levels were low enough to explain the observed malnutrition (poor dentition, esophageal candidiasis, & low weight).