Background: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their engagement influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium on PICCs placed in hospitalized medical patients […]

Background: Until the advent of novel oral anticoagulants (NOACs), Warfarin was the only oral agent available for the treatment of deep venous thrombosis (DVT) and Pulmonary embolism (PE). Bridging with parenteral anticoagulation until warfarin reaches a full therapeutic level often results in prolonged hospitalization. Rivaroxaban, Dabigatran, Apixaban, Edoxaban were approved by the FDA for DVT […]

Background: Deep Vein Thrombosis (DVT) is a pathology characterized by the formation of a blood clot inside the venous system. It comprises either distal vein thrombosis, but also proximal vein thrombosis (i.e. Femoral, Popliteal and Iliacal veins), which leads to a significant increase in complications of the disease, such as pulmonary thromboembolism (PE) and even […]

Case Presentation: A 56-year-old-male with hypertension, diabetes mellitus, chronic kidney disease (CKD) stage 3 presented with a 6-month history of intermittent lower extremity swelling and a 3-week history of scrotal and abdominal swelling. 9 months prior, he was noted to have worsening renal function and nephrotic range proteinuria (13g) prompting two renal biopsies which demonstrated […]

Case Presentation: A 64-year-old Middle-Eastern man with a history of rheumatic heart disease status post mechanical mitral Starr-Edwards ball-in-cage valve (in 1968), atrial flutter on coumadin and prior ischemic stroke with residual blindness presented with 4 days of “bloody” urine. Physical exam was significant for scleral icterus, an unchanged holosystolic murmur, and the observation of […]

Case Presentation: A 48-year-old man with a history of gastroesophageal reflux disease and obstructive sleep apnea presented with one week of pain, warmth, and rash over the right foot accompanied by episodic fever and headaches. He was a landscaper. Six weeks ago, he fell from a ladder with resultant right nondisplaced medial malleolar and comminuted […]

Case Presentation: A 71-year-old man with type 2 diabetes mellitus, hypertension, coronary artery disease, and peripheral arterial disease presented with worsening bilateral lower extremity pain which started two days prior to admission. Physical exam revealed cold and pale lower extremities, tenderness, and absence of pulses on both lower limbs but no edema or ulceration. Range […]

Case Presentation: A 39-year-old construction worker with no past medical history presented to the hospital with a 2-week-history of fatigue and left upper quadrant abdominal pain associated with intermittent high fevers and chills. Patient reports his 9-year-old daughter was sick with fevers and an upper respiratory tract infection a month ago right after a camping […]

Case Presentation: A 52-year-old male with medical history of diabetes mellitus, hypertension, and hyperlipidemia presented to ER for right upper extremity swelling for 3 days. He reported a feeling of heaviness in his right arm and associated pain with movement. He denied any trauma, history of blood clots, or cancer and endorsed a family history […]

Case Presentation: A 54-year-old female presented with painful swelling in the left lower extremity. She had a similar complaint over 30 years ago when she was on oral contraceptives and was eventually diagnosed with a deep venous thrombosis(DVT) in the left leg. Vitals showed an oral temperature of 36.7degree celsius , heart rate of 76, […]