Chief Complaint E.O. is a 53-year-old African-American female who complains of mouth pain after 4 weeks of therapy with exemestane plus everolimus. Relevant Medical History • Recurrent metastatic estrogen receptor/progesterone receptor–positive, HER2/neu–negative breast cancer that has progressed • Cancer has metastasized to her bones (according to previous scans). • Eastern Cooperative Oncology Group performance status…
By: Paul Bowlin, MD; E. David Crawford, MD A 72-year-old male presents with fatigue and shortness of breath. On initial laboratory evaluation, he is found to have a hematocrit level of 55%. His past medical history is significant for hypertension, hyperlipidemia, coronary artery disease, and gastroesophageal reflux disease. Surgical history is only notable for cardiac…
By: C. Andrew Kistler, MD, PharmD, RPh A 63-year-old man presents to the hospital with a history of recurrent infections that include cellulitis, pneumonias, and upper respiratory tract infections. He reports subjective fevers at home along with unintentional weight loss and occasional night sweats. The patient has a remote history of arthritis, which was diagnosed…
By Sandra Cuellar, PharmD, BCOP A 63-year-old male is referred by his primary care physician for work-up of possible lung cancer. The patient has a history of shortness of breath and persistent cough (with no accompanying hemoptysis) and a chest x-ray is suspicious for malignancy. The patient has not experienced any weight loss. Past medical…
By Justin M. Watts, MD; Peter Maslak, MD; Martin S. Tallman, MD A 47-year-old woman presented for evaluation of pancytopenia. She had been diagnosed with papillary thyroid cancer 18 months earlier and underwent total thyroidectomy followed by radioiodine (I-131) ablation for nodal and small pulmonary metastases. Cumulative dose of radioactive iodine was 312 mCi. She…
By Barbara Ann Burtness, MD A 52-year-old man who lives in the Midwest presents with a lesion in his nose. He has an extensive history of sun exposure and a 35 pack-year smoking history. The patient sought attention from an otolaryngologist, who cultured the lesion in the right upper medial nasal vestibule but noted “no…
Chief Complaint AG, 64-year-old gentleman of Greek descent, presents with a 6-month history of rash that started on his upper extremities and now includes his lower extremities. Physical Examination • Rash apparent on arms and legs; it appears raised and red in color, and is more pronounced on his legs, which contains red and blue…
Byline: Sandra Cuellar Puri, PharmD, BCOP Chief Complaint During a routine follow-up visit, WM, a 48-year-old female, complains of ongoing fatigue since the beginning of cytotoxic chemotherapy, 6 months after initiating trastuzumab. Physical Exam • At 6 months following initiation of single-agent trastuzumab, a multigated acquisition (MUGA) scan revealed left ventricular ejection fraction (LVEF) dropped…
Chief Complaint MP is a 38-year-old woman who comes to the clinic with a temperature of 101F and complains of abdominal pain approximately 14 days after her last chemotherapy treatment. Results of Last Visit During her last appointment, MP denied fevers, chills, or other signs/symptoms of infection but, due to laboratory results, was initiated on…
Chief Complaint DC, a 54-year-old male diagnosed with multiple myeloma, develops a low grade fever and some mild diarrhea 10 days after receiving a successful autologous hematopoietic stem cell transplant (HSCT). Physical Exam • Low grade fevers persists for several days • All other vital signs remaining stable• His physical exam is benign with no…
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