Background: Hematopoietic stem cell transplantation (HSCT) can be a life-saving and curative therapy in hematological malignancies. Pre-transplant evaluation for HSCT is a multidisciplinary process that can be complicated, time-consuming, and expensive for patients to navigate. The process requires coordination between several medical subspecialties including pulmonary, cardiology, and mental health, in addition to social workers and [...]

Background: Myelofibrosis is a chronic myeloproliferative neoplasm characterized by progressive bone marrow fibrosis and extramedullary hematopoiesis leading to splenomegaly. Progressive splenomegaly is common in advanced myelofibrosis, and spleen volume is a predictor of survival. The oral selective small-molecule JAK 1/2 inhibitor ruxolitinib is used for symptomatic management of intermediate-2 and high-risk myelofibrosis, and leads to [...]

Background: Successful hospitalist co-management programs address provider knowledge base as well as ongoing faculty skill development and education (1). With a growing liver transplant program, our institution has seen increased patient volume on the hospitalist liver service. Hospitalists and hepatologists co-manage this expanding population of high acuity patients with complex pathologies. In the past year, [...]

Background: Patients with transplanted organs often have longer lengths of stay and readmissions compared to general internal medicine patients. Atypical presentations may result in unnecessary tests, missed diagnoses and incomplete treatment. Nephrologists and hospitalists bring different strengths and experiences to the management of such patients. Here we present an analysis of quality metrics as well [...]

Case Presentation: A 32-year-old South Asian woman with history of IgA nephropathy complicated by end stage renal disease status post renal transplant (CMV/EBV positive), latent tuberculosis infection, C. Diff colitis, and recurrent urinary tract infections presented with two days of fevers and diarrhea. One week prior to admission she was seen at a local ED [...]

Case Presentation: The patient is a 58-year-old male with a past medical history of end-stage liver cirrhosis status post-liver transplantation in 1991 who was on tacrolimus (TAC) 1 mg twice a day. He was admitted for altered mental status, fever and respiratory distress. He was found to have bilateral pneumonia treated as community-acquired pneumonia. The [...]

Case Presentation: An 18-year-old woman who presented with a year history of recurrent painless gross hematuria and a 3-year history of anemia requiring continuous oral iron replacement therapy and subsequent blood transfusions. On further evaluation, she was also found to have significant proteinuria with preserved renal excretion function and a negative autoimmune panel. A renal [...]

Case Presentation: A 65 year old male with no significant medical history presented to an outside facility complaining of fatigue, weakness, nausea and vomiting. He had moderate alcohol history and significant weight loss over the past 6 months. Initial lab workup was notable for elevated liver transaminases with a hepatocellular pattern, Maddrey score of 53.6 [...]

Case Presentation: A 53-year-old woman with a history of metabolic syndrome and necrotizing pancreatitis presented with new onset ascites. Her story began nine months earlier, when she developed abdominal pain. CT at that time revealed pancreatitis and cholelithiasis without biliary dilation. Lab values were notable for: lipase 55000, total bilirubin (TBIL) 5.3, AST 660, ALT [...]

Case Presentation: A 60-year-old male presented with one week of new onset fevers and fatigue. Past medical history included primary sclerosing cholangitis, orthotopic liver transplant 12 years ago and Epstein-Barr virus (EBV) negative post transplant lymphoproliferative disease (PTLD) with partial response to single-agent Rituximab treatment one-year prior.The patient reported debilitating fatigue, daily low-grade fevers, night [...]