Tag Archives: hematology
Doppler assessment by transesophageal echocardiogram of severe mitral stenosis.

Diagnostic and Management Dilemma: Massive Hemoptysis from Severe Mitral Stenosis

Severe hemoptysis in a critically ill patient must prompt rapid development of a broad differential. We present an unusual case that presented a diagnostic and management dilemma. A 55-year-old man presented to the Emergency Department with dyspnea and hemoptysis. He was hemodynamically unstable, requiring intubation and pressor support. Assessment On examination, he was afebrile and […]

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Hemoglobin A1c trend before and after proprotein convertase subtilisin/kexin 9 inhibitor (PCSK9I) therapy. Hemoglobin A1c values prior to PCSK9I therapy were in the range of 6.4% to 7.3%. After initiation of therapy, they slowly trended up, eventually doubled, and then improved after discontinuation of the medication.

Doubling of Hemoglobin A1c on PCSK9 Inhibitor Therapy

A 70-year-old man with history of cerebrovascular accident, hyperlipidemia, and type 2 diabetes mellitus presented with polyuria, polydipsia, and weight loss. Severe hyperglycemia (serum glucose, 585 mg/dL) was present on admission. No precipitating factors were identified. Initial laboratory findings were also notable for elevated aspartate aminotransferase (703 IU/L) and alanine aminotransferase (779 IU/L). Diabetes mellitus, […]

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Intra-Abdominal Varix Rupture: A Life-Threatening Cause of Hemoperitoneum

A 54-year-old male with decompensated alcoholic cirrhosis presented after a syncopal event and ground-level fall. Initial examination noted a distended abdomen without overlying bruising. At admission, his hemoglobin was 6.3 g/dL from a baseline of 8-10 g/dL. A computed tomography scan of the abdomen was notable for “complex ascites” adjacent to his liver concerning for […]

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Black flies, also known as buffalo gnats or turkey gnats, are blood-feeding insects in the insect family simuliidae. Immature black flies breed in fast-flowing water, from which the adults emerge in great swarms (usually) in spring or early summer. Black flies are notorious nuisance pests in certain parts of the world and are vectors of the agent of onchocerciasis in tropical areas. Nuisance biting alone can be serious, even fatal, with many reports of livestock and poultry deaths due to black fly biting.1, 2, 3 Outbreaks were a major problem in the southern United States during the early 20th century1 but disappeared until recently. This reemergence may be due to the elimination of harsh pesticides and the cleaning up of creeks and rivers.

Black fly bite reactions include papules, erythematous wheals, indurations, or extensive swelling of the affected area.4 In addition, adenopathy (black fly stiff neck) may occur from bites on the face, neck, and scalp.2 There are many reports of reactions to black fly biting in the northern United States and other parts of the world,2,5, 6, 7 but none from the southern United States, where black flies have typically not been a problem. Here we carefully document the timeline of bites and subsequent development of cutaneous lesions in an entomologist who was investigating a black fly outbreak along the Pearl River in central Mississippi during the spring of 2018.

Methods
The entomologist bitten by black flies was examined by the second author and bite reactions were described and photographed over the following 72 hours. Samples of the offending insect were collected and identified as Simuliim meridionale.

Results
From March 26 to April 2, at least 10 black fly bites were noted on the patient's arms, neck, and face. Bite reactions sometimes developed into large indurations by 48 hours (Figure 1). Two bites on the neck were carefully followed for 48 hours (Figure 2). At first, there was nothing but erythema and a small hemorrhagic center. Four hours later, lesions developed into a central wheal with surrounding erythema. The diagnosis was papular urticaria, presumably resulting from hypersensitivity to black fly salivary proteins. A raised urticarial papule developed at each bite site with surrounding erythema that itched intensely. Over the course of 24 hours, the urticarial lesions resolved, leaving only an erythematous flattened lesion. By 48 hours, the lesions had completely faded.

Development and Resolution of Cutaneous Lesions Caused by Black Fly Bites (Diptera: Simuliidae)

Black flies, also known as buffalo gnats or turkey gnats, are blood-feeding insects in the insect family simuliidae. Immature black flies breed in fast-flowing water, from which the adults emerge in great swarms (usually) in spring or early summer. Black flies are notorious nuisance pests in certain parts of the world and are vectors of […]

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