PulmPEEPs 52. Fellows’ Case Files: University of Pittsburgh
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Aug 29, 2023 Joining the discussion are Rachel Wojcik, a rising third-year fellow in PCCM with a passion for medical education, and Stephanie Maximus, an assistant professor dedicated to training future physicians. They dive into a challenging case involving an elderly patient with unique complications, showcasing the complexities of diagnosing pulmonary issues in immunocompromised individuals. The duo emphasizes the importance of collaborative decision-making and interdisciplinary teamwork in patient care, along with insights into diagnosing rare infections like nocardia.
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Broad Differential in Immunocompromised
- In immunocompromised patients with lung lesions, consider infections, malignancy, and inflammatory disorders broadly.
- Ask about steroid dose, prophylaxis, splenectomy history, and examine skin for nodules to guide diagnosis.
Collaborate for Diagnostic Precision
- When evaluating lung and skin lesions with CNS findings, coordinate with ID and rheumatology for a focused workup.
- Include blood cultures, fungal markers, ANA, ANCA, and consider rare infections and vasculitis in the differential.
Strategic Bronchoscopy Use
- Bronchoscopy decisions should balance patient risk and diagnostic yield, starting with less invasive options.
- Use BAL with fungal markers like galactomannan and beta-D glucan for better infection diagnosis in immunocompromised patients.