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Open Journal of Nephrology 2022年第1期12卷 124-132页

作者： Joseph I. Berger Natalia Pogosian hanady zainah St. John’s Riverside Hospital Yonkers New York USA

We present the 3rd known case of a Serratia rubidaea urinary tract infection in a 49-year-old male with past medical history of bilateral lower extremity paraplegia who presented to the emergency room with fever, lethargy, and red tinted urine. The Serratia genus, of the family Enterobacteracia, in particular the species marcescens, are important causes of infection in humans, animals, and insects, however, until the mid-1950s, this was not the case, and the organism was considered non-pathogenic and frequently used in medical experiments. Serratia are facultatively anaerobic, gram-negative rods, the majority with peritrichous flagella primarily inhabiting soil, water, and plant surfaces. Serratia marcescens is now a known pathogen, however, less frequently isolated species, including Serratia rubidaea, are worthy of discussion, especially due to its characteristic red color and rarity. We aim to increase the awareness Serratia rubidaea including its presentation, inherent antimicrobial resistance, and treatment options.

关键词： Urinary Tract Infection Enterobacteracia Serratia rubidaea Serratia marcescens Prodigiosin Bacteremia

A Patient with Acute Liver Injury after Sulfamethoxazole/Trimethoprim Treatment for Pyelonephritis

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Open Journal of Nephrology 2020年第4期10卷 367-374页

作者： Maria Green Sarah Baroud Martin Sayegh hanady zainah St. John’s Riverside Hospital Yonkers New York USA Sheikh Khalifa Medical City Abu Dhabi UAE

Background: Sulfamethoxazole/Trimethoprim is a commonly used drug in a variety of clinically indicated scenarios, but it is not without side effect. Case-reports have stated that adverse reactions secondary to Sulfamethoxazole/Trimethoprim can present very early in the course of treatment, especially in patients who have a higher predisposition. Thus, the burden is placed on the clinician to be wary of these side effects and be able to recognize them in the correct clinic scenario. Objective: To discuss the risk of developing cholestatic hepatic dysfunction secondary to treatment with sulfamethoxazole/trimethoprim. Methods: We present the history, physical findings, laboratory investigations, and clinical course of a 47-year-old African-American female who developed cholestatic hepatic dysfunction after treatment with sulfamethoxazole/trimethoprim for pyelonephritis. Results: Drug-induced liver injury is a rare complication of sulfamethoxazole/trimethoprim therapy and only 20% of cases are secondary to cholestatic hepatic dysfunction. Our patient, who had been on sulfamethoxazole/trimethoprim for 7 days for pyelonephritis, presented to our hospital with a clinical picture consistent with hepatic injury;her laboratory investigations were noteworthy for an elevated white blood cell count, platelet count, and elevated transaminases, along with alkaline phosphatase levels greater than 2 times the upper limit of normal. Promptly following the discontinuation of sulfamethoxazole/trimethoprim, our patient improved clinically and her liver enzymes down-trended during the course of her hospital stay. She returned to normal at her 4 month follow up, thus confirming the diagnosis of cholestatic hepatic dysfunction secondary to sulfamethoxazole/trimethoprim. Conclusion: Cholestatic hepatic dysfunction is a form of drug-induced liver injury and a rare complication of sulfamethoxazole/trimethoprim treatment. The

关键词： Sulfamethoxazole/Trimethoprim Cholestatic Hepatic Dysfunction

Leukocytoclastic Vasculitis Following Ceftriaxone Exposure

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Open Journal of Nephrology 2022年第2期12卷 222-227页

作者： Alyssa Damstrom Saira Khan Urma Jalil Eno-Obong Effiong Michael Corti hanady zainah Lake Erie College of Osteopathic Medicine Erie USA Department of Internal Medicine St Johns’ Riverside Hospital Yonkers USA Department of Hospital Medicine St. John’s Riverside Hospital Yonkers USA St. John’s Riverside Hospital Yonkers USA

Leukocytoclastic vasculitis (LCV) is an immune-complex mediated inflammation of dermal capillaries and venules that can occur after infections, drugs, autoimmune disorders, neoplasms, or idiopathically. We present the case of a 59-year-old male who was treated with ceftriaxone for an abscess, S. aureus cellulitis, and osteomyelitis of his right second toe. Biopsy confirmed the diagnosis of LCV and symptoms resolved after ceftriaxone was discontinued and systemic corticosteroids were introduced.

关键词： Leukocytoclastic Vasculitis Immune-Complex Ceftriaxone LCV

An Atypical Cause of Abdominal Pain in an Elderly Patient

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Open Journal of Nephrology 2021年第3期11卷 370-378页

作者： Yaroslav Andrew Jakymec Cara Sherman Michelle Annabi-Rabadi Majed Samarneh hanady zainah Lake Erie College of Osteopathic Medicine Erie Pennsylvania USA Department of Medicine St. John’s Riverside Hospital Yonkers New York USA

Background: Henoch-Schonlein Purpura (HSP), or IgA vasculitis, is the most common vasculitis in children and is characterized by four symptoms: palpable purpura with no concurrent thrombocytopenia or coagulopathy, arthritis/ arthralgias, abdominal pain, and renal disease. HSP does occur in older patients at a much lower frequency. Objective: To discuss the atypical presentation of HSP in an elderly adult and the increased nephrogenic risks that are involved in this patient group. Case Presentation: We present the history, physical findings, laboratory results, and the clinical course of a 74-year-old Caucasian male with an atypical presentation of HSP. Our patient presented with severe gastrointestinal and cutaneous symptoms which occurred after the onset of abdominal pain. Biopsies demonstrated leukocytoclastic vasculitis in the skin and acute inflammation and hemorrhage in the gastrointestinal tract. The diagnosis was confirmed as IgA vasculitis following the renal biopsy. The patient’s symptoms improved with the administration of methylprednisolone. Conclusion: In adults with HSP there is greater concern regarding renal involvement and a greater risk of developing end-stage renal disease compared to children. The importance of recognizing HSP in the elderly is imperative for early diagnosis and appropriate treatment to limit renal damage.

关键词： Henoch-Schonlein Purpura IgA Vasculitis Leukocytoclastic Vasculitis