2021-11-22-mr.md (1750B)
1 # Morning Report 2 3 ## Case 4 5 CC: HA, vision loss 4mo 6 7 HPI: 8 64F, Korean, healthy (minor arthritis). 9 Developed daily HA 4mo, intermittent but can last all day. 10 +jaw claudication, TTP both sides of head. Not positional. APAP w/o much improvement. 11 No aura, some +n/v. 12 1mo vision loss R eye lateral fields, blurry; R leg weakness, cannot lift leg. 13 Daily subjective fevers, 14 Mild weight loss. 15 16 PCP started pred 20 2-3d with some improvement in arthralgias. 17 18 PMH: 19 HTN, OA 20 21 Meds: 22 lisinopril, pred 20 2-3d 23 24 FH: 25 not much known 26 27 SHx: 28 moved from Korea in 1980s, no smoking, no EtOH, works as seamstress 29 30 PE: 31 vss af, +proximal muscle weakness 2/5 R leg, plantar/dorsiflexion intact, sensation wnl. Reflexes 2+. 32 Visual fields R sided lateral weakness, nondilated exam w/o macular edema. No rash, all joints wnl. 33 34 Labs: Na 129, CBC 11.7, CRP low, ESR 3, INR wnl, LFT wnl. 35 36 CXR: L apical PTX. 37 CT: 1.8cm LUL mass, spiculated w pleural tenting. 38 MRI brain/C spine: L lateral transverse sinus filling defect (not clearly thrombus) 39 40 ### Pearls 41 42 - GCA ~20% have ESR wnl. 43 - GCA is MCC otherwise unexplained fever >3wk in adults >60yo (~30%) 44 - ESR is primarily measure of fibrinogen concentration, unlikely to drop fast w a few days of relatively low-dose steroids 45 - some series describe an increased incidence of malignancy w/in 6-12mo of GCA dx, however it appears this may be mostly d/t increased follow-up and extensive workup 46 47 48 ## Case 49 50 Eos 5200. 51 52 DRESS Dx criteria 53 - RegiSCAR score: 54 - fever >100.4 55 - LA 56 - eos 57 - >50% BSA rash or bx proven 58 - organ involvement (liver, kidney, lung, heart, muscle, pancreas) 59 - duration >15d 60 - exclusion of other causes (list of labs that need ordered) 61 62 PREDICT-1 trial (HLA-B*5701 screening for ABC hypersensitivity)