Hidradenitis Case Study

This is an 82-year-old gentleman, who was referred from Dr. Gretchen Marsh’s office because the patient’s BUN and creatinine were high, as he has acute kidney injury. The patient went to Dr. Marsh’s office yesterday and was having generalized weakness. He does not have any vomiting. No diarrhea. No fever. No cough with expectoration. No sharpness. No wheezing. No headache. No dizziness. No passing out. No rectal bleeding. No hematemesis. No abdominal pain. No sore throat. No stuffy nose. No cough with expectoration. No burning, frequency, or

wants to evaluated for hep C, was a IV drug use, multiful tatoos, and history of inprsionment. This is 32 year old white male. Patient is a resident at Aletheia House. Patient is a current smoker with 16 pack year history. Patient reports he had stoped using IV drugs on 6/26/2015 (second time clean, last was in 2011). Patient denies chest pain, SOB, N/V/D, or fever. Patient denies depressive moods. current pain 6/10.

On the same date an abdominal x-ray was also completed which revealed no small bowel dilation, no free gas, with a few small pelvis phleboliths (venous calcifications) noted. My involvement and care of the patient occurred Feb 22nd. On this date her lab work was: BUN 6.3, Cr 64, Na 138, K+ 3.5, Cl 107, C02 22, WBC 8.2 (15.4 Feb 15, 4.1 Feb 17), Hgb 93 (106 Feb 15, 80 Feb 16, 73 Feb 17), Hct .291, Plts 305. On assessment the client was still on contact plus isolation, but both a stool C+S and C-Diff tests were negative. Vitals: T 35.8, P 68 reg, RR 18, BP 94/52, Spo2 98% room air, Pain 0/10 (did receive 650mg acetaminophen @ 0630 for chronic Lt arm/hand pain).

Patient History: my patient is a 79 y/o female. She weighs 71.7 kg and is 165.1 cm tall. She has a history of colon carcinoma and hypertension. She has had a previous cholecystectomy, appendectomy, and removal of a uterine polyp. She has no history of bleeding disorders. She was a smoker, but quit 30 years ago. She smoked a half pack per day for 10 years; rare alcohol use. She is status post right-hemicolectomy. She is allergic to penicillin.

The patient had no systemic symptoms and denied any unexplained abdominal pain. Physical examination was negative for cervical lymphadenopathy and salivary gland swelling. Computer tomography (CT) of the thorax, abdomen, and pelvis and bloodwork to evaluate renal, liver, and thyroid were ordered. The IgG4 serum level was found to be elevated at greater than 3.30 g/L (normal range was between 0.03 to 2.01 g/L). Given that bloodwork for renal, liver, and thyroid function was normal and that the patient was asymptomatic at the time, immunosuppressant therapy was not started and a 3 month follow-up was

Patient F.C. is a 63-year-old African American male, who presents to the emergency department with intense left upper quadrant pain that radiates to his back and under his left shoulder blade; stating, “It feels like I have a knife in my stomach”. He reports the upper abdominal pain is intermittent, onset 3 weeks ago; however, the pain has been increasing in severity for the past four days. He states “he has been feeling very warm with episodes of nausea for the past 4 days” with a noted an 8-10 pound weight loss in the past 45 days. He denies any diarrhea or blood in his stool; however, he notes a reduction in the frequency of his bowel movements.

Family history: Mmother, alive at the age of 31, with a history of aplastic anemia, s/p liver and stem cell transplant after being diagnosed with fulminant

A review of his medical record indicates that a history of ESRD, chronic immunosuppressive therapy post cardiac transplant in 1988, hypertensive kidney disease, RT AVG infection, Cad, MRSA and skin cancer. He has had multiple hospitalizations for AVG infection. His last hospital admission was 10/14/16 for left AVG infection which as removed by DR. Thai, treated for MRSA bacteremia and placement of Right AVG.

The patient is a 19-year-old male named Matt. He was being treated for lethargy, excessive thirst, recent unexpected weight loss, fever, and complaints of frequent urination. Matt is a college cross-country runner who is otherwise is healthy. He is currently uninsured and his diet consists of fast food meals and prepackaged meals. Also, he consumes 3-4 beers about 3-4 days a week. Matt is allergic to Penicillin as well as Sulfa Drugs. After the assessment Matt has a temperature of 101.6 F and has a pain level of 4/10 while urinating in which he experiences a burning pain. His skin is warm and dry and has a 1 inch by 5/8th inch skin break on the posterior right ankle that has not healed in 3 weeks. Additionally, Matt was treated once in

Hidradenitis Suppurativa (HS) was first documented in medical literature in 1839 by Dr. Alfred Velpeau, and was thought to be a severe form of acne inversa. Dr. Velpeau reported a patient with abscess formations in the armpits, under the breasts, and the anus. In 1854 Dr. Artistide Verneuil associated the abscesses with the sweat glands and the condition was named. Alternatively, HS is known as Verneuil’s disease. The name Hidradenitis Suppurativa highlights the key features of the disease, Hidraden means referring to the sweat gland, itis means inflammation, and suppurativa means to produce pus.

Crackles are noted in the lungs throughout. Heart is regular rate and rhythm with a rate in the 90s. Patient is on telemetry. Bowel sounds are active x4. Denies abdominal tenderness. Skin is dry and intact.

Hidradenitis suppurativa is a clinical diagnosis; no specific test is well established. Therefore, high clinical suspicion is mandatory10-14. We observed that more than 50% of our patients had a past history of previous episodes of misdiagnosis and treatment done by many health care practitioners at their local premises.

This patient is a 62-year-old male who required inpatient hospitalization due to: Mr. C had a

The patient is a 69-year-old woman who has COPD, and asthmatic bronchitis; who presents for evaluation of increasing shortness of breath, cough, and increased sinus congestion and pressure. She has been on steroids because of exacerbation of asthma now for some time, is actually on 40 mg daily. In spite of this she notes ongoing wheezing, and shortness of breath when doing her exercise tolerance. She has had no high fevers, no localized chest pain. She is using her inhalers as prescribed. Others at time in [Place] have also had an upper respiratory illness. She wanted to make sure she would not need antibiotics. She has had some facial pain, that seems to better today. She had some yellow discharge that now seems to be clear. The patient did

CHIEF COMPLAINANT: Patient is a known diabetic, he has been converted over to insulin, he has been doing very well. His blood sugars are running in the low 100's, in the last month he has had one episode of blood sugar 57, otherwise, has done very well. He watches his diet, he tries to stay active. He has a known prior history of a lung resection for neoplasm, he has not been coughing up any blood. He does has some flem at times he has difficulty clearing. No chills or fever. No chest pain. No swelling in his legs, no leg sores. He sees podiatry every 3 months and he has an eye clinic scheduled for next month.