Morning report

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Morning report

• Mariam Abboud
• August 09

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Case Presentation

• 88 yo lady, transfer from OSH
• CC cough, hemoptysis, anemia, leukocytosis

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PMH

• HTN on lisinopril/atenolol
• Hypothyroidism
• Neurogenic bladder on oxybutinin
• PSH AAA in 04, HH, SBO
• Family Hx son MLC (48), daughter MBC (68)

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History, chronological order

• Early July cough and white sputum
• Treated as a bronchitis azythro,
  chlorpheniramine/codeine
• 1 week later fatigue,wheezing
  salmeterol/fluticasone, antihist.
• 7/28 JFK for tachypnea and SOB.
• Few days later hemoptysis started.

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OSH

• WBC 30-40 left shift
• Anemia
• BNP 354, CRP 15.2, LAP stain 245 (H)
• CT Scan b/l patchy infiltrates, minimal
  pericardial eff. , HH, LN
• Echo EF 65aortic sclerosis, mild AR, TR, mod
  Pulm HTN

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OSH

• Treated as CHF then PNA
• 6 PRBC
• Vanco,levo, then pip-taz for citrobacter and
  finally tigecycline
• Mycoplasma Ab (-)
• FISH no abnl myeloid maturation or increased
  blasts , no BCR-ABL
• Cx
• Ceretec Scan

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On admission

• T 98.6 HR 84 BP 178/79
• RR 20 SaO2 98 on 2L
• NAD, AAO3
• Skin
• LAD
• B trace scattered rales / cough
• Heart
• Abdomen
• LEE 1
• Neuro/Psych

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Labs
128
95
53
63
4.9
22
1.2
WBC 43.5 / Hb 9.5/ N 75 /B 21/ Eo 1/ M 1 /L 1/
PLT 191 INR 1.5/ PTT 45 AST 62/ ALT 12/ TB 1.2 D
0.2/ AP 179 / prot 5.9
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Clinically

• Low SaO2
• BNP 2654
• LD 1644 Uric Acid 9.2
• WBC 45?38?61.8?60.8?70.1?77.8
• N 64-82 B 13-29 Toxic granulation
• Worsening anemia 6.9 s/p 2 PRBC
• Bronchoscopy / Steroids

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Other labs..

• ANA
• ANCA
• GBM Ab
• Cryo
• JAK 2
• BCR ABL mutation PCR
• OSH BMB

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ICU
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Differential

• Pulmonary edema
• Plavix
• Coagulopathies
• TB
• Fungal (Aspergillus)
• PCP
• Sarcoidosis
• SLE
• Isolated Pulmonary Capillaritis
• Wegener
• Churg-Strauss
• Goodpasture
• PAN
• Cryo
• COP
• Hyperleukocytosis / Leukemia
• Drugs