Cervical Cancer in Hispanic Women

Background: Cervical cancer is the fourth most common cancer in women and although the number of cases in the United States has decreased significantly, it is estimated that 14,480 new cases of invasive cervical cancer will be diagnosed in the United States in 2021. With the Hispanic population being the fastest growing demographic group in the United States, Hispanic women are 40% more likely to be diagnosed with cervical cancer and 20% more likely to die from cervical cancer. Case Presentation: 29-year-old Hispanic female with history of cervical cancer status post hysterectomy and chemotherapy presents with complaints of vaginal bleeding for several months associated with fever, chills, generalized body aches and left flank pain. She has a left nephrostomy tube in place from left sided hydronephrosis. Urine cultures showed gram negative rods. She failed outpatient treatment with Cefdinir and was started on IV Zosyn. However, the patient left against medical advice and was advised to follow up with her oncologist and urologist. Conclusion: The USPSTF recommends screening for cervical cancer at the age of 21 and routine vaccination at age 11. Due to disparities such as limited access to healthcare, lack of education, language barrier, many women do not get screened or do not return for follow up appointments after an abnormal result. Providing more access to cervical cancer screening and education about risk factors associated with cervical cancer as well as the importance of primary prevention are all ways to help women have a healthier lifestyle and improve quality of life

Gangrenous Appendicitis in an Elderly Male

Background: Appendicitis is one of the most common causes of acute abdomen with 250,000 cases reported annually in the U.S. Clinical manifestations include right lower quadrant abdominal pain, nausea, vomiting, and low grade fever. However, in the elderly population they may present with atypical or non-specific symptoms of appendicitis. Case Presentation: An 82-year-old Hispanic gentleman presents to the emergency department with chief complaint of epigastric pain, dizziness and vomiting after eating breakfast in the morning. He reports the epigastric pain is sharp, 4/10, radiating to the left arm with no alleviating or aggravating factors. Vitas on presentation showed a temperature of 98.6F, BP 108/50, heart rate 87, SpO2 94%. Labs revealed an elevated white cell count of 13.68, creatinine of 1.6, high sensitivity troponin of 105. An abdominal ultrasound was ordered which was unremarkable and CT abdomen and pelvis without contrast showing fluid filled distended loops of small bowel likely the result of an abdominal ileus. The patient continued to have worsening abdominal pain in the following days with physical exam now revealing rebound tenderness, guarding and signs of peritonitis. Leukocytosis worsened to 15.58 and surgery was consulted. The patient was taken for an exploratory laparotomy and was found to have a perforated gangrenous appendix. Conclusion: One in every 2000 adults over the age of 65 will develop appendicitis annually, making it an important cause of abdominal pain in this age group. The elderly have a higher rate of perforation at the time of presentation with one study stating that the mortality rate from perforated appendicitis in patients over the age of 80 was 21%. Elderly patient’s may not present with the classic presentation of appendicitis as seen in this case and thus, a high degree of suspicion is needed to make a prompt diagnosis. Although it is a condition we mostly see in the younger population, it is important to keep appendicitis as a differential diagnosis in the elderly

A Case of Disseminated Cryptococcosis

Background: Cryptococcus is an invasive fungal infection, typically acquired through inhalation. It is found in soil contaminated with bird droppings and it can disseminate to the lungs, meninges, and skin. In the United States, the incidence of cryptococcosis is estimated to be about 0.4-1.3 cases per 100,000 population with the most common species being Cryptococcus Neoformans and Cryptococcus Gatti. Cryptococcosis is commonly seen in HIV patients, however, immunocompromised individuals with cancer, solid organ transplants, or chronic glucocorticoid therapy are also at high risk. Case Presentation: A 69-year-old male with history of polymyositis and granulomatosis polyangiitis on chronic steroids presents to the ER with chief complaint of progressively worsening shortness of breath and confusion of three days duration, as per patient’s wife. Patient had been noted to be more lethargic and confused with increased productive cough. Chest x-ray and high-resolution CT demonstrated bilateral dense multilobar infiltrates and he was started on Ceftriaxone, Azithromycin and Solu-Medrol for multilobar pneumonia. A serum cryptococcal antigen was ordered by infectious disease which came back positive with titers of 1:2560 and thus, he was started on Amphotericin B and Flucytosine. A lumbar puncture was then performed which showed Cryptococcal Neoformans and Cryptococcus Gatti positive in CSF. Unfortunately, the patient’s condition deteriorated, and he expired. Conclusion: Cryptococcosis predominantly occurs in HIV patients. We need to have a high index of suspicion in immunosuppressed patients including patients on chronic steroids that are at high risk of developing cryptococcosis. Prompt recognition and treatment is critical as there is a high mortality rate

Severe Hypokalemia Secondary to Distal Renal Tubular Acidosis in a Hispanic Man

Introduction: Renal tubular acidosis is a rare renal disorder that can cause severe electrolyte imbalances which can be life threatening. Case: A 21-year-old man presented to the ED on account of generalized weakness and body aches of one day duration. He reported no past medical history other than a previous episode of similar symptoms with improvement after IV hydration and electrolytes replacements about 2 months prior. He was not taking any medications and denied vomiting, diarrhea nor any significant family history. He admitted to alcohol and marijuana use. Physical examination was significant for reduced muscle power, tone, and reflexes in all extremities. He was unable to move his limbs against gravity. Admission laboratory findings revealed severe hypokalemia 1.1 mEq/L, metabolic acidosis with bicarbonate of 10.1 and EKG showed QT prolongation. Patient received a total of about 200 mEq of potassium through a central line in 24 hours with serum level of 3.7mmol/l in addition to intravenous bicarbonates with a resolution of the presenting symptoms. Discussion: The causes of hypokalemia are broad however a methodical approach can be helpful to rule out the many causes and narrow down the differential diagnosis. Distal RTA is caused by the inability of the distal renal tubule to secrete hydrogen ions due to the selective failure of activity or expression of the H+-ATPase. Conclusion: This case underscores the importance of systematic approach to the evaluation of patients with hypokalemia to uncover the cause of the underlying disease before life threatening complications occur. Our patient remains under close follow up