Broward Health

Introduction: Disseminated Candida auris infection presenting with fungal pericarditis is a life-threatening infection typically associated with immunosuppression, cardiac surgery, or prolonged antibiotic use. Fungal species comprise less than 1% of pericardial infections, with Candida auris—an emerging multidrug-resistant yeast—rarely implicated; only one documented case of Candida auris pericarditis has been reported in the literature, resulting in death. Description: A 54-year-old man with end-stage renal disease (ESRD) on hemodialysis due to IgA nephropathy, type 2 diabetes, and recent diagnosis of endocarditis at an outside hospital presented with shortness of breath and anemia (hemoglobin 6.0 g/dL). His medical history included ulcerative colitis (post-colectomy), L4-L5 osteomyelitis, stroke, and recent PFO closure. Echocardiography revealed a moderate pericardial effusion, leading to a left anterior thoracotomy with pericardial window creation. Intraoperative pericardial and pleural fluid were cloudy, with WBC 1000/mm3 (neutrophil predominance). Gram stain was negative; cultures grew C. auris. Blood cultures remained sterile. The patient was initially started on micafungin, but due to lack of clinical response, therapy was switched to liposomal amphotericin B while awaiting susceptibility results. He subsequently improved and remains hospitalized under close supervision monitoring. Discussion: This is the second reported case of C. auris pericarditis worldwide. Risk factors included ESRD, cardiac hardware, and broad-spectrum antibiotic use. The infection remained localized without fungemia, highlighting the importance of direct sampling. Early surgical drainage and rapid microbiological identification allowed for prompt targeted treatment. This case underscores the need to consider fungal etiologies in high-risk ICU patients with pericardial effusion and highlights C. auris as an emerging critical care threat that requires enhanced surveillance and infection control measures. Sources: (Ruiz-Gaitán et al., JMM Case Rep 2018). (Chowdhary et al., PLoS Pathog, 2016; CDC, 2024).

Introduction: Very Severe Hypertriglyceridemia (VSHTG), defined as triglyceride (TG) levels >2,000 mg/dL, is a rare but serious cause of acute pancreatitis and may account for up to 10% of cases. Prompt and aggressive reduction of triglycerides is essential to minimize systemic inflammation and prevent multiorgan failure. While insulin and fibrates are standard first-line treatments, therapeutic plasma exchange (TPE) can be life-saving in rapidly progressive or refractory cases. Description: A 39-year-old man with no known medical history presented with acute epigastric pain. Laboratory evaluation revealed lipase 250 U/L, urine glucose >1,000 mg/dL, urine ketones 80 mg/dL, serum glucose 436 mg/dL, venous pH 7.04, sodium 108 mmol/L, chloride 79 mmol/L, and negative troponin. CT of the abdomen and pelvis showed inflammatory changes in the pancreatic tail. Triglycerides were >5,000 mg/dL. He was admitted to the intensive care unit for management of diabetic ketoacidosis (DKA) and hypertriglyceridemia-induced acute pancreatitis. Despite initial management with intravenous fluids, insulin infusion, and bowel rest, his triglyceride levels remained markedly elevated, and his clinical condition deteriorated. TPE was initiated within 24 hours of admission, resulting in rapid biochemical and clinical improvement. The patient was discharged on insulin, fibrates, and with comprehensive lifestyle counseling. Outpatient follow-up with endocrinology and lipidology was arranged. Discussion: VSHTG is a rare but life-threatening cause of acute pancreatitis that requires early recognition and targeted intervention. This case highlights the importance of identifying secondary contributors (such as previously undiagnosed diabetes) and initiating extracorporeal lipid-lowering therapy when conventional treatments are inadequate. Early plasmapheresis may offer significant benefit in critically ill patients with refractory disease. Long-term success depends on addressing underlying metabolic abnormalities to prevent recurrence.

Dermatologic and musculoskeletal presentations in pediatric patients can pose significant diagnostic challenges, particularly when findings are atypical, persistent, and resistant to therapy. We present a diagnostically complex case of a 13-year-old male with a history of multiple psychiatric comorbidities who developed progressive bilateral pedal edema, bullous lower extremity lesions with excoriations, and severe pain, all symptoms seemingly refractory to antibiotics. Despite initial concern for skin and soft-tissue infection, symptoms persisted, prompting inpatient evaluation and an expanded serologic workup. Screening for immunologic and infectious causes, including human immunodeficiency virus (HIV) and sexually transmitted infections, revealed a new diagnosis of HIV-1 acquired through non-perinatal transmission. The patient was concurrently diagnosed with atypical IgA vasculitis, raising consideration of infectious versus drug-related triggers based on his medication regimen. Although vasculitis is uncommon in HIV-positive patients, and IgA vasculitis is even rarer, this case emphasizes the importance of a broad differential diagnosis in pediatric patients with multisystem involvement. Ultimately, close attention to atypical presentations can ensure timely diagnoses and better care for patients facing similarly complex conditions.

Walking is a fundamental activity of daily living that is often taken for granted despite the prevalence of plantar foot pain among adults. Ultrasound serves as a valuable tool for assessing plantar foot pain due to its accessibility and affordability and the superior resolution of high-frequency transducers. Differentiating between the various entities that cause plantar foot pain requires special attention to patient positioning, transducer choice, machine settings, and diagnostic maneuvers. By leveraging proper scanning technique and recognizing sonographic hallmarks, ultrasound practitioners can enhance evaluation of plantar foot pain, providing definitive diagnoses in many cases and guiding further management. This review highlights sonographic techniques and key imaging findings for common plantar foot abnormalities, including soft-tissue masses, inflammatory and infectious conditions, traumatic injuries, and vascular abnormalities. Additionally, MRI will be discussed as a useful adjunct when further imaging assessment is required.

Pyosalpinx is a rare infection of the fallopian tube characterized by pus accumulation and inflammation, which can progress to severe sepsis if not promptly treated. We describe a 54-year-old premenopausal woman who presented with fever, localized abdominal pain, and laboratory findings consistent with sepsis. Diagnostic imaging revealed a complex adnexal mass concerning for a tubo-ovarian abscess. Despite empiric broad-spectrum antibiotic therapy, the infection persisted, prompting a robotic-assisted total laparoscopic hysterectomy with bilateral salpingo-oophorectomy for definitive source control. Surgical pathology confirmed pyosalpinx with abscess formation. The presence of clue cells and the absence of sexually transmitted pathogens suggested bacterial vaginosis as the likely infectious source. This case emphasizes that upper genital tract infections can occur in women without traditional risk factors and that altered vaginal flora may play a significant role in their development. Prompt diagnosis, empiric antibiotic coverage, and timely surgical intervention remain crucial to prevent complications and ensure favorable outcomes.

Advances in tissue engineering have enhanced our understanding of wound healing, leading to more effective management of acute and chronic wounds. Bioengineered skin constructs are increasingly favored for their minimal invasiveness and efficacy. Full-thickness neck wounds in premature neonates pose unique reconstructive challenges due to limited treatment options, high infection risk, and the potential for contracture formation. We present a rare case of an infected neck/shoulder wound in a premature infant with immunodeficiency. Following surgical debridement, a bilayered cellular skin substitute, Apligraf (Organogenesis Inc., Canton, USA) was applied to promote wound closure. Given the lack of reports describing the use of Apligraf for complex neck wounds in premature infants, this case demonstrates its potential as a viable reconstructive option in this vulnerable population, achieving early and cosmetically acceptable closure.

Dalam pelaksanaan pengklaiman rawat inap di RSUD Dr. Moewardi masih terdapat kesenjangan tarif antara tarif riil dengan tarif INA-CBGs. Pasien rawat inap pada kasus odontectomy juga termasuk dalam sepuluh besar tindakan rawat inap tahun 2022 dan semester 1 tahun 2023. Tujuan penelitian ini adalah Untuk mengetahui perbedaan antara tarif riil dengan tarif INA-CBGs pasien rawat inap kasus odontectomy. Rancangan penelitian ini adalah observasional analitik dengan pendekatan komparatif. Populasi penelitian ini adalah lembar klaim individual pasien keluaran E-klaim pasien rawat inap pada kasus odontectomy bulan Januari sampai dengan Juni Tahun 2023 sejumlah 310 dokumen. Sampel yang diambil adalah sampel jenuh artinya seluruh populasi digunakan untuk sampel yaitu 310 dokumen. Pengumpulan data dengan menggunakan Check list. Analisis data menggunakan uji wilcoxon. Hasil penelitian menunjukkan perhitungan secara menyeluruh terdapat 274 kasus memiliki selisih negatif dan 36 kasus memiliki selisih positif. Rata-rata tarif riil pasien rawat inap kasus odontectomy sebesar Rp. 10.229.267,93, sedangkan rata-rata tarif INA-CBGs pasien kasus odontectomy sebesar Rp. 833.7291,94. Jika diperhitungkan secara keseluruhan maka total tarif riil rumah sakit lebih besar dari total tarif INA-CBGs dengan selisih negatif Rp 552.412.559 maka rumah sakit bisa dikatakan mengalami kerugian. Simpulan dalam penelitian ini adalah ada perbedaan tarif riil dengan tarif INA-CBGs pasien rawat inap kasus odontectomy di RSUD Dr. Moewardi Surakarta sehingga disarankan pihak manajemen rumah sakit melakukan monitoring dan evaluasi secara berkala terhadap klaim pasien kasus odontectomy

Background: Proton pump inhibitors (PPIs) are commonly prescribed for acid-related conditions, especially in patients with cardiovascular risk factors. Although widely considered safe, emerging evidence suggests potential associations with adverse vascular outcomes. The impact of chronic PPI use on clinical outcomes among patients undergoing coronary artery calcium (CAC) imaging is not well characterized. Objective: To assess whether chronic PPI use is associated with adverse cardiovascular outcomes in adults undergoing CAC imaging. Methods: We conducted a retrospective cohort study using the TriNetX Research Network. Adults ≥18 years with ≥2 CAC-related cardiac CT scans (CPT 75571–75574) were included. Patients with prior coronary artery disease, MI, coronary revascularization, chronic kidney disease stage ≥4, malignancy, or H2 receptor antagonist use were excluded. Two cohorts were defined: chronic PPI users and non-users. After 1:1 propensity score matching on age, sex, hypertension, diabetes, obesity, smoking, and hyperlipidemia, each cohort included 4,346 patients. Outcomes included ischemic stroke, MI, and all-cause mortality. Survival analyses were conducted using Kaplan-Meier curves and Cox proportional hazards models. Results: Following matching, baseline characteristics were balanced. Over a median follow-up of approximately 1.4 years, all-cause mortality was significantly higher among PPI users (3.0%) compared to non-users (0.9%) (hazard ratio [HR] 0.329, 95% CI: 0.232–0.468, p<0.001). Ischemic stroke was also more frequent in the PPI group (3.3% vs. 1.6%; HR 0.513, 95% CI: 0.385–0.682, p<0.001). MI incidence did not differ significantly (3.6% vs. 3.2%, p=0.408). No coronary revascularization events were reported in either cohort. Conclusion: In patients undergoing CAC imaging, chronic PPI use was associated with increased risk of all-cause mortality and ischemic stroke, but not MI. These findings suggest potential long-term cardiovascular risks of PPI therapy in at-risk populations and support the need for further prospective evaluation. Relevance to Cardiology: PPIs are often co-prescribed in cardiology, especially in patients on antiplatelet therapy. This study raises concern about their long-term cardiovascular safety and underscores the importance of judicious PPI use in preventive cardiology.