Duffyriddle6402

28±14.22 (p<0.001)]. Out of the 12 patients with a severe deficiency, three-fourths of the population had DM as comorbidity, while in those with 'deficiency', 19 (67.9%) had DM. The majority of the patients without DM had adequate or optimum levels of serum 25-hydroxyvitamin Dlevels.

Current study indicated that deficiency of serum vitamin D is associated with concomitant DM in patients with CKD as the majority had a severe deficiency of serum 25(OH)D. Supplemental vitamin D may help correct the deficiency and prevent the associated complications in patients.

Current study indicated that deficiency of serum vitamin D is associated with concomitant DM in patients with CKD as the majority had a severe deficiency of serum 25(OH)D. Supplemental vitamin D may help correct the deficiency and prevent the associated complications in patients.To our knowledge, this is the first reported case of a severe acquired von Willebrand's Syndrome (avWS) in association with a Glioblastoma Multiforme (GBM). We report a case of a 70-year-old male who presented to the hospital with neurologic findings secondary to a thalamic mass and subsequent hydrocephalus but without any prior history of any bleeding diathesis. A biopsy and septum pellucidotomy was considered and coagulation parameters from pre-operative chemistry returned deranged. Further investigations for bleeding disorders have been performed and an avWS was diagnosed due to the low levels of factor VIII, vWFAg, and vWFRiCoF. The patient responded to a single dose of IVIG and hence the contemplated procedure has been performed. Subsequently, a histopathologic diagnosis of a GBM was made and unfortunately no further treatment was pursued due to the patient's poor response to the initial surgical intervention.Staphylococcus species are a leading cause of community-acquired bacteremia. Of them, the most serious cause of mortality is from methicillin-resistant Staphylococcus aureus, with mortality rates as high as 40%. Another Staphylococcus species that has been noted to cause equal levels of infection and mortality is Staphylococcus lugdunensis (S. lugdunensis). It can cause harmless skin infections to life-threatening endocardial complications. We would like to report a rare presentation of S. lugdunensis bacteremia from a lymphocele that developed post surgery. An 80-year-old male presented to the emergency department with complaints of abdominal pain and fevers. Cultures of lymphocele fluid grew S. lugdunensis. A computed tomography of the abdomen and pelvis with contrast showed the presence of a large lymphocele. S. lugdunensis is a coagulase-negative staphylococci normally known to be a skin colonizer. Over the years, it has shown to cause a wide variety of infections especially involving prosthetic joints and heart valves. S. lugdunensis has been noted to be highly susceptible to penicillins, such as oxacillin, erythromycin, linezolid and a wide a variety of other antibiotics. S. lugdunensis produces a biofilm that makes treatment challenging even with susceptible antibiotics. However, the data on S. lugdunensis is growing as more case reports are being published in regards to source and susceptibilities.Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic pauci-immune small vessel vasculitis. Its various presentations make AAV diagnosis challenging. Here, we present a case of AAV with thrombotic microangiopathy (TMA) and deep venous thrombosis (DVT). An 82-year-old Hispanic woman presented to the emergency department with malaise, lower extremity pain, and oliguria for three days. Her vital signs were normal, and her physical examination was unremarkable. The initial laboratory revealed thrombocytopenia (18 x 103/µL), elevated creatinine (8.35 mg/dL), high lactic acid dehydrogenase (1627.5 U/L), an international normalized ratio of 1.6, and an activated partial thromboplastin time of 49 seconds. Urinalysis showed microscopic hematuria and proteinuria, and peripheral smear revealed schistocytes. She was admitted with concern for TMA. Further workup revealed an antinuclear antibody titer of 180, an ADAMTS13 level of 62%, a rheumatoid factor level of 151.7 IU/L, and myeloperoxidase (MPO)-ANCA level of 173 AU/mL. A computed tomography scan of the chest/abdomen/pelvis revealed pulmonary fibrosis and multifocal consolidations. She was also found to have extensive DVT of the lower extremities. Renal biopsy revealed early changes of TMA with one cellular crescent. She was diagnosed with AAV based on the kidney and lung findings, as well as the high titer MPO-ANCA. Her platelet count and creatinine improved significantly following treatment with plasma exchange, steroids, and rituximab. Unfortunately, she was then found to have an acute bowel perforation and expired. Even though typically rare, an increased incidence of venous thromboembolism (VTE) and TMA has been reported in patients with AAV. Its prompt recognition and treatment by clinicians are critical to mitigate the unfavorable outcomes from this condition.We report a case of a 16-year-old Hispanic male, without history of systemic illness, who presented with altered mental status and fevers since two weeks prior to evaluation. Further history revealed one-month complaints of headaches, nocturnal fevers, right knee and elbow pain, fatigue, loss of appetite, transient finger discoloration, and a nine-pound weight loss. Physical exam was remarkable for a thin male with pale mucosa, petechia on palate and distal extremities, malar rash that included nasal bridge and cervical and posterior lymphadenopathy. Laboratory work-up showed pancytopenia, with elevated ferritin value of 11,320 ng/mL. The patient was diagnosed with juvenile-onset systemic lupus erythematosus (JSLE) with macrophage activation syndrome (MAS) and suspected antiphospholipid syndrome (APS). Our patient's predominant presentation were neurological symptoms. These can be seen in up to one-third of patients with MAS. They can range from headache, seizures, altered mental status, irritability, and lethargy. Other symptoms are fevers, lymphadenopathy, and hepatosplenomegaly. Ferritin values above 10,000 are highly specific and sensitive for MAS. Z-IETD-FMK concentration Albeit a more common presentation in juvenile idiopathic arthritis, MAS can also present across other auto-immune diseases.