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Case Report
Early Lyme Disease: Solving the Subtle Clinical Clues in an Elderly Patient
Case Presentation
A 63-year-old woman presented in June complaining of a 1-week history of malaise, headache, generalized body aches, and low-grade fever of 101 degrees F. She denied any upper respiratory, gastrointestinal, or other associated symptoms. Physical examination was generally unremarkable with the exception of a slightly raised, 8 x 6–cm, irregular, ovoid patch with spotty areas of mildly intense-to-faded erythema found on her right anterior thigh (Figure 1). A central papule was noted, consistent with a punctum from a recent tick or insect bite (Figure 2). When the lesi
A Case of Scurvy in an Elderly Patient
CASE PRESENTATION
A 70-year-old man was brought to the emergency room by his neighbor, who reported a 10-day history of progressive fatigue, leg pain, and generalized weakness. The patient had suffered an ischemic stroke 7 months before and was dependent on his neighbor for his daily care. His past medical history was significant for hypertension. His caretaker also commented on the patient’s decline in function during the last month, noting some “bloody stools,” shortness of breath, “easy bruising,” leg swelling, and a recent “red rash” on his arms and legs. The patient had no
Radiation-Induced Primary Malignant Lymphoma of the Brain
INTRODUCTION
Radiation-induced1,2 second primary malignant tumors include meningiomas, sarcomas, and gliomas. Patients who received prophylactic intracranial irradiation and intrathecal methotrexate for acute lymphocytic leukemia or lymphoma may occasionally also develop brain tumors. Such tumors consist mainly of glioma. Rarely, meningioma, meningeal melanocytoma, fibrosarcoma, and primitive neuroectodermal tumor have also been described.1,3 We report herein an interesting case of primary central nervous system (CNS) lymphoma developing 8 years after irradiation for ca
A Case of Vanishing Bile Duct Syndrome
CASE PRESENTATION
A 75-year-old Haitian man presented to the emergency department (ED) with altered mental status (disoriented to time and place). Although a poor historian, he did report progressive worsening of vision in his eyes bilaterally over an approximate 2-week period. Past medical history included type 2 diabetes mellitus for approximately 6 years and hypertension. He was not compliant with medications for these chronic conditions as prescribed by his primary care physician and was taking no medications at the time of assessment in the ED. Social history was significant for alcohol
Iodine-Induced Hyperthyroidism (Jod-Basedow Phenomenon) in the Elderly
Iodine-induced hyperthyroidism, or Jod-Basedow phenomenon, a thyrotoxic condition caused by exposure to increased amounts of iodine, has historically been reported in regions deficient in iodine.1 However, with advances in contrast imaging, this hyperthyroidism has more recently been reported in patients following studies that require administration of iodine-containing contrast media,2-5 but has received little attention in the elderly,6,7 who frequently undergo such studies. The increasing application of these imaging techniques to evaluate and prognosticate diseases of advanced age, in comb
Spontaneous Spinal Epidural Hematoma in an Older Woman on Warfarin
CASE PRESENTATION
An 86-year-old woman presented to the emergency department complaining of left-sided flank pain that had awoken her from sleep earlier that morning. She rated the pain severity as 6 on a scale of 1 to 10, with radiation to the left groin and no relief on position change. She had no hematuria, dysuria, fever, or chills. Past medical history included a stroke at age 83, with no residual deficits, hypertension, atrial fibrillation, depression, and pacemaker for sick sinus syndrome. Her medications were warfarin 5 mg daily, digoxin 0.25 mg daily, fosinopril 10 mg daily, and mir
Temporal Arteritis with Occult Malignancy: Co-existence or Causal Relationship?
CASE PRESENTATION
A 74-year-old white male was referred to the ophthalmologist with a 3-week history of difficulty in reading and diminution of vision. He also complained of a right-sided headache, which was throbbing in nature and episodic, each episode lasting a few hours. On direct questioning his wife said that he had been getting progressively more tired over the past few weeks. There was no apparent loss of weight. He had no history of shoulder stiffness or joint pains or any other significant past medical history. Clinical examination revealed vision of 20/60 in each eye with glasses.
Use of the “Decoy” Catheter to Prevent Traumatic Foley Removal
Delirium occurs in 14-56% of elderly hospitalized patients.1 During these times of confusion, traumatic self-removal of an indwelling urinary catheter with the balloon inflated can occur, resulting in urologic consultation. The use of a “decoy” catheter in a patient with dementia has been previously described to prevent repeated catheter removal.2 We believe this is an underutilized, simple alternative to sedatives and restraints that may prevent the confused patient from removing his or her urinary catheter.
CASE PRESENTATION
A 90-year-old male resident in a nursing facility was
Diastolic Heart Failure in the Older Patient
CASE PRESENTATION
ER is a 76-year-old African-American woman with a history of coronary artery disease (CAD), myocardial infarction, stroke, hypertension, diabetes, and chronic renal insufficiency, who had a pacemaker placed for symptomatic bradycardia. The patient was transferred from a nursing home for evaluation of acute shortness of breath and chest tightness that was different from her typical anginal chest pain. She denied fever, chills, cough, nausea, vomiting, palpitations, and near syncope or syncope. The patient had at least two hospital admissions in the past year for decompensat
Clinical Geriatrics Blogs
Coming in Future Issues of Clinical Geriatrics
Series: Diabetes in the Elderly
Series: Cancer in Older Adults
First Report® Conference Coverage: American Academy of Neurology, American Diabetes Association, 2010 Digestive Disease Week
Assessment and Classification of Pain in the Elderly Patient
Pharmacologic Management of Pain in Older Patients
Miscellaneous Pain Syndromes in Older Adults
Nonhernia Causes of Inguinal Pain in the Elderly
