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71. Fellows’ Case Files: University of New Mexico
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Manage episode 416918247 series 3299598
Today we’re visiting the University of New Mexico for another interesting entry in our Fellows’ Case Files.
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Case-Files-1-1024x1024.png)
Meet Our Guests
Neel Vahil is a second-year internal medicine resident at the University of New Mexico. He completed medical school at New York Medical College and is planning on applying to pulmonary critical care fellowship programs.
Ishan Patel is a third year PCCM fellow at the University of New Mexico and will be pursuing a second fellowship in clinical informatics this year. He completed medical school and residency in Internal Medicine at Oregon Health & Science University. His fellowship research has focused on clinical outcomes of intensivist-led ECMO programs.
Dr. Lucie Griffin completed her internal medicine residency and PCCM fellowship at the University of New Mexico and is currently the Director of the Albuquerque VA medical intensive care unit.
Case Presentation
A 69 year old male veteran who presents with 6 weeks of weight loss, cough, and malaise. He has ongoing tobacco use, and history of rheumatoid arthritis on HCQ and weekly MTX with etanercept, which he had stopped taking in the three prior months. Vitals: Afebrile, mildly tachycardic to 101, BP of 93/59, saturating appropriately on room air without any signs of respiratory distress
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide6.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide7.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide8.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide9.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/CXR-Front.png)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/CXR-Lateral.png)
Key Learning Points
- Rheumatoid effusions can be a pulmonary manifestation of uncontrolled, active rheumatoid arthritis
- The pleural fluid characteristics of rheumatoid effusions can be similar to that of malignancy, active bacterial infection, or tuberculosis including a high ADA level, low glucose, and a low pH
- The presence of Rheumatoid factor with concomitant negative evaluation for active infection or malignancy can help narrow the differential diagnosis to rheumatoid effusion
- Complications are mostly related to long-standing residual inflammatory fluid and can be a fibrothorax with the presence of pneumothorax ex vacuo, which can be managed by observation unless severe
References and Further Reading
Komarla A, Yu GH, Shahane A. Pleural effusion, pneumothorax, and lung entrapment in rheumatoid arthritis. J Clin Rheumatol. 2015;21(4):211-215.
Boddington MM, Spriggs AI, Morton JA, Mowat AG. Cytodiagnosis of rheumatoid pleural effusions. J Clin Pathol. 1971;24(2):95-106.
Balbir-Gurman A, Yigla M, Nahir AM, Braun-Moscovici Y. Rheumatoid pleural effusion. Semin Arthritis Rheum. 2006;35(6):368-378
73 قسمت
Fetch error
Hmmm there seems to be a problem fetching this series right now. Last successful fetch was on May 21, 2024 02:18 ()
What now? This series will be checked again in the next day. If you believe it should be working, please verify the publisher's feed link below is valid and includes actual episode links. You can contact support to request the feed be immediately fetched.
Manage episode 416918247 series 3299598
Today we’re visiting the University of New Mexico for another interesting entry in our Fellows’ Case Files.
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Case-Files-1-1024x1024.png)
Meet Our Guests
Neel Vahil is a second-year internal medicine resident at the University of New Mexico. He completed medical school at New York Medical College and is planning on applying to pulmonary critical care fellowship programs.
Ishan Patel is a third year PCCM fellow at the University of New Mexico and will be pursuing a second fellowship in clinical informatics this year. He completed medical school and residency in Internal Medicine at Oregon Health & Science University. His fellowship research has focused on clinical outcomes of intensivist-led ECMO programs.
Dr. Lucie Griffin completed her internal medicine residency and PCCM fellowship at the University of New Mexico and is currently the Director of the Albuquerque VA medical intensive care unit.
Case Presentation
A 69 year old male veteran who presents with 6 weeks of weight loss, cough, and malaise. He has ongoing tobacco use, and history of rheumatoid arthritis on HCQ and weekly MTX with etanercept, which he had stopped taking in the three prior months. Vitals: Afebrile, mildly tachycardic to 101, BP of 93/59, saturating appropriately on room air without any signs of respiratory distress
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide6.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide7.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide8.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/Slide9.jpeg)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/CXR-Front.png)
![](https://www.pulmpeeps.com/wp-content/uploads/2024/05/CXR-Lateral.png)
Key Learning Points
- Rheumatoid effusions can be a pulmonary manifestation of uncontrolled, active rheumatoid arthritis
- The pleural fluid characteristics of rheumatoid effusions can be similar to that of malignancy, active bacterial infection, or tuberculosis including a high ADA level, low glucose, and a low pH
- The presence of Rheumatoid factor with concomitant negative evaluation for active infection or malignancy can help narrow the differential diagnosis to rheumatoid effusion
- Complications are mostly related to long-standing residual inflammatory fluid and can be a fibrothorax with the presence of pneumothorax ex vacuo, which can be managed by observation unless severe
References and Further Reading
Komarla A, Yu GH, Shahane A. Pleural effusion, pneumothorax, and lung entrapment in rheumatoid arthritis. J Clin Rheumatol. 2015;21(4):211-215.
Boddington MM, Spriggs AI, Morton JA, Mowat AG. Cytodiagnosis of rheumatoid pleural effusions. J Clin Pathol. 1971;24(2):95-106.
Balbir-Gurman A, Yigla M, Nahir AM, Braun-Moscovici Y. Rheumatoid pleural effusion. Semin Arthritis Rheum. 2006;35(6):368-378
73 قسمت
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