1/10. levofloxacin-induced bilateral Achilles tendonitis.OBJECTIVE: To report a case of possible levofloxacin-induced bilateral Achilles tendonitis. CASE SUMMARY: An 83-year-old white woman presented to her physician with five days of hemoptysis. She was diagnosed with right lower-lobe pneumonia based on chest X-ray, and levofloxacin 500 mg/d po for 10 days was prescribed. Three days into treatment she began having a variety of adverse effects, including severe nausea, constipation, stomach cramps, and dizziness. Signs of tendonitis began three days after treatment and peaked four days after completion of therapy. Two weeks later, she was treated by her podiatrist with an ankle immobilizer and rest. At her three-week follow-up, she had marked improvement in her pain and bruising; however, her symptoms had not completely resolved. DISCUSSION: Tendonitis and tendon rupture are rare adverse effects of fluoroquinolone antibiotics; there are no reports in the literature of levofloxacin-induced tendonitis. As newer fluoroquinolones become available, the postmarketing studies will become increasingly important to capture the data on rare but serious adverse effects not discovered in the premarketing trials. CONCLUSIONS: To our knowledge, this is the first reported case of tendonitis caused by levofloxacin reported in the literature. Reports have been made, however, to the manufacturer via postmarketing surveillance. As more people are treated with newer fluoroquinolones, the clinical incidence of tendon rupture with these agents may become clearer.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Just another hemoptysis or a fluke?Hemopytsis is commonly encountered in the daily practice of the pulmonary physician. Younger patients with normal chest x-rays frequently have acute or chronic bronchial disease accounting for their complaint. Occasionally parasitic disease is described as an unusual cause for a patient presenting with hemoptysis. Although pulmonary paragonimiasis is unusual in this country, because of the rapid growth in travel as well as immigration, physicians will need to be aware of this disorder.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/10. Aortobronchial fistula: a rare etiology for hemoptysis.Aortobronchial fistula is an extremely rare cause of hemoptysis. Aortobronchial fistula occurs in patients who have a history of thoracic vascular surgery. Because its symptoms are nonspecific, a high index of suspicion is critical if the physician is to detect it. The results of imaging studies (e.g., plain films, computed tomography, and angiography) and bronchoscopy are sometimes, but not always, diagnostic--another reason the diagnosis is difficult. Left untreated, mortality in patients with aortobronchial fistula is 100%. patients can be salvaged by a variety of techniques, including the placement of an endovascular stent. We describe the case of a 52-year-old man who came to us with hoarseness and hemoptysis, which proved to be underlying symptoms of aortobronchial fistula. He was treated successfully.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. The pulmonary physician in critical care. Illustrative case 1: cystic fibrosis.The case history of a patient with CF admitted to an ICU is presented and the appropriateness of intensive care management for patients with CF is discussed. Issues relevant to the ICU care of patients with CF are highlighted.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
5/10. hemoptysis in a 28-year-old active duty soldier.A 28-year-old African American male, originally from West africa, presented with complaints of cough and hemoptysis. This case follows the patient through transfer to Walter Reed Army Medical Center and outpatient follow-up. Exploring this case illustrates how an Army physician may approach a soldier with hemoptysis. Additionally, this case demonstrates the management and treatment of his condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. hemoptysis: a manifestation of pulmonary disease confidently managed by military physicians.Military physicians can confidently manage hemoptysis with a systematic approach and optimal timing of consultation. Begin with a thorough history, physical examination, and chest x-ray. In our series of 177 cases, a cause for hemoptysis was found in 78% of those with abnormal chest x-rays but in only 21% of those with normal chest x-rays. All 36 cases of bronchogenic carcinoma were associated with an abnormal chest x-ray. A normal chest x-ray was associated with no cause found for the hemoptysis (44 cases) or bronchitis (25 cases), with no carcinomas developing upon a 2-year follow-up. hospitalization is indicated with excessive bleeding or to allay patient or physician) anxiety. Diagnostic bronchoscopy is usually indicated, especially to localize the bleeding in massive hemoptysis (greater than 600 cc per 24 hours) when surgery may be indicated. Prompt referral should be the rule with bleeding from a mycetoma, diffuse bronchiectasis, or with recurrent significant hemorrhage (greater than 200 cc). In an active-duty population, these instances are fortunately rare, and conservative management and elective referral are the norm.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
7/10. Bronchial angiography: a report of 21 patients.Angiographic studies of the bronchial and other systemic thoracic arteries were requested by referring physicians in 21 patients, in 18 cases because of hemoptysis. Selective catheterization was carried out in 18 of the 21, and in an additional two patients the bronchial arteries were identified by thoracic aortography. Five examples of effective therapeutic embolization are discussed. Bronchial angiography and embolization appear to be of value in the diagnosis and treatment of hemoptysis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Severe, acute pulmonary disease in patients with systemic lupus erythematosus: ten years of experience at the National Institutes of health.The sudden development of diffuse pulmonary infiltration in a patient with SLE presents difficult diagnostic and therapeutic problems to the clinician. In the past ten years, we have seen eight patients with this problem. Neither roentgenograms nor clinical findings were specific. In six patients, pulmonary hemorrhage was found, but in only two of them did it exist alone. In the other four, heart failure, uremia, and coagulopathy complicated the findings. In one patient, P carinii was the cause; in one congestive heart failure, which was not obvious clinically or radiologically, was the cause. Three patients died: one of uncomplicated pulmonary hemorrhage, one with pulmonary hemorrhage occurring during the treatment of pneumonia due to L bozemanii, and one with pulmonary hemorrhage and multiple complications including sepsis due to candida. On the basis of this experience, we have recommended a plan of action for physicians facing this problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Infected false aneurysms of the subclavian artery: a complication in drug addicts.Two cases of infected false aneurysms of the subclavian artery in drug addicts are described. The clinical findings related to the location of these rare lesions are presented, together with an attempt to explain their pathophysiology. The signs and symptoms include a tender supraclavicular mass in an obviously septic patient associated with brachial plexus palsy, a swollen edematous arm, Horner's syndrome, and hemoptysis. Because of the complexity of symptoms, delay in diagnosis is common. It is emphasized that the recognition of this constellation of symptoms should prompt the physician to perform emergency angiography followed by immediate surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. cystic fibrosis in an elderly woman.cystic fibrosis (CF) is thought of by most physicians as a disease of children. Advances in therapy have extended the life span of patients so that many pulmonary internists have responsibility for the care of young adults with CF. Nevertheless, the initial diagnosis of CF after the age of 30 years is unusual, and a diagnosis after the age of 60 years is rare. Such a case is reported here.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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