2020-07-02-noon-conference.md (1465B)
1 # Case 1: New, acute onset ascites and abdominal pain 2 3 Portal vein thrombosis often does *not* have remarkable LFT changes. 4 5 Triple-phase CT - indicated when? 6 7 Malignant culture-negative neutrocytic ascites - case reports in 2017 and 2019, no clear guidance for management 8 9 # Case 2: 10 11 beta-D-glucan - invasive fungal infx test, takes time to result (how long? how good?) 12 13 GMS stain - identifies many kinds of fungi, pathologists mostly report morphology with possibilities that require clinical correlation <https://cmr.asm.org/content/24/2/247> 14 15 ## pneumocystis jirovecii pneumonia in non-HIV infx pts 16 17 Stem cell tx, solid organ tx, heme malignancies, high-dose steroids, immunosuppression 18 19 Risk for solid organ tx depends on tx, ?mostly d/t degree of immunosuppression 20 21 Presents with nonspecific sx: dysnpea, fever, dry cough, hypoxia out of proportion to level of distress (this last point a personal obs from presenter - mb worth a study!) 22 23 Definitive dx with GMS from sputum or BAL, direct fluorescent antibody, PCR (PCR may have higher diagnostic yield) 24 25 Presumptive dx (may be too hypoxic for bronchoscopy): increased beta-D-glucan, radiographic findings, clinical features, possibly increased LDH, and r/o other fungal causes 26 27 Firstline tx: TMP-SMX 15-20mg/kg, desensitize if minor allergy+steroids if severe (low PaO2 or requiring supplemental O2) 28 29 Secondline tx: clindamycin+primaquine; clindamycin+primaquine or TMP + dapsone if moderate; 21 total days.