Hoboken University Medical Center is a community hospital located in Hoboken, New Jersey with 190 beds. It was founded in 1863 as St. Mary Hospital and operated under that name until 2007. The hospital is owned by Hudson Hospital Opco, known as CarePoint Health, an organization that also owns Bayonne Medical Center and Christ Hospital. The hospital is an academic affiliate of New York Medical College and was previously an academic affiliate of New Jersey Medical School.
Abstract Introduction Bronchiolitis obliterans organizing pneumonia (BOOP), also referred to as cryptogenic organizing pneumonia when idiopathic, is a rare non-infectious inflammatory lung disease characterized by intraluminal fibroblastic plugs within alveolar ducts and bronchioles. Despite distinct histology, its nonspecific features often mimic other diseases, leading to misdiagnosis. In the absence of known triggers such as infection, drug toxicity, or connective tissue disease, idiopathic BOOP in an otherwise healthy adult represents an uncommon and diagnostically challenging presentation. Case Report A 51-year-old previously healthy male presented with a 2.5-week history of worsening dry cough, dyspnea, fatigue, myalgias, and unintentional weight loss. He denied fever or recent infections. His occupational history was notable for chronic dust and fume exposure as a construction manager, and he smoked half a pack of cigarettes daily.On arrival, he was afebrile but tachycardic (96 beats per minute) and mildly hypertensive (156/99 mmHg), with oxygen saturation of 95% on room air. Laboratory evaluation revealed leukocytosis (white blood cell count 13.0 × 109/L), normocytic anemia (hemoglobin 12.5 g/dL), and markedly elevated inflammatory markers (CRP 142.3 mg/L and ESR 96 mm/hr). Chest radiography demonstrated bilateral punctate opacities, and high-resolution computed tomography (HRCT) showed diffuse centrilobular nodules without consolidation or lymphadenopathy—findings concerning for miliary tuberculosis or vasculitis.He was empirically treated with broad-spectrum antibiotics and placed under airborne isolation for possible tuberculosis (TB). Interferon-gamma release assay (IGRA) was negative, and acid-fast bacilli (AFB) testing was nondiagnostic. Bronchoscopy with transbronchial biopsy revealed intra-alveolar fibroblastic plugs (Masson bodies) and chronic interstitial inflammation, diagnostic of BOOP. No granulomas or infectious organisms were identified.The patient was started on oral prednisone, with rapid symptomatic improvement and complete radiographic resolution on follow-up imaging. He remains asymptomatic six months later on a tapering steroid regimen. Discussion This case illustrates a rare presentation of idiopathic BOOP masquerading as miliary TB in an immunocompetent host. The combination of diffuse nodular infiltrates and systemic symptoms initially directed evaluation toward infectious etiologies, delaying definitive diagnosis. The absence of known precipitating factors highlights its cryptogenic nature and underscores the diagnostic value of histopathologic confirmation in non-resolving pneumonitis.BOOP is an underrecognized, steroid-responsive interstitial lung disease where early treatment prevents irreversible fibrosis. This case emphasizes the need for heightened clinical suspicion for organizing pneumonia in atypical radiologic presentations, even among healthy adults, reinforcing the importance of multidisciplinary evaluation in rare pulmonary pathologies. This abstract is funded by: None
Abstract Introduction A sympathetic pleural effusion (SPE) is a sterile, nonmalignant pleural fluid collection that arises secondary to an inflammatory or infectious process outside the thoracic cavity, most commonly within the abdomen. SPEs are typically unilateral; bilateral involvement is exceedingly rare. We present an unusual case of bilateral SPEs developing in response to right-sided emphysematous pyelonephritis with perinephric hematoma. Case Presentation A 55-year-old woman with uncontrolled diabetes mellitus, hypertension, and hyperlipidemia presented with one week of dyspnea, cough, and pleuritic chest pain. Physical examination revealed right flank tenderness and decreased breath sounds at the left lung base. Laboratory findings included leukocytosis (18 × 103/µL), anemia (7.5 g/dL), hyponatremia (122 mmol/L), and elevated creatinine (3 mg/dL). Urinalysis was consistent with infection. Retroperitoneal ultrasound demonstrated right-sided emphysematous pyelonephritis. CT abdomen revealed a hemorrhagic right perinephric collection with gas. A percutaneous drain was placed, and cultures grew Klebsiella pneumoniae. Drain fluid measuring creatinine levels confirmed a collecting system fistula, prompting ureteral stent placement for source control. Despite improvement in flank pain, the patient developed acute hypoxemia. CT chest revealed bilateral pleural effusions. Left thoracentesis yielded an exudative effusion by Light’s criteria, with negative cultures and cytology. Persistent effusion required chest tube drainage. Subsequent right-sided thoracentesis demonstrated a similarly sterile, nonmalignant exudate. The patient improved with drainage, diuresis, and targeted antibiotics. Follow-up imaging confirmed complete resolution of bilateral effusions and perinephric infection. Discussion This case highlights an uncommon manifestation of sympathetic pleural effusion. SPEs occur due to transdiaphragmatic spread of inflammatory mediators or fluid from subdiaphragmatic infections, increasing pleural vascular permeability. They often mimic infectious or malignant effusions because of their exudative nature, but lack microbial or malignant cells. While unilateral effusions are typical, bilateral SPEs are exceedingly rare. To our knowledge, few reports link bilateral exudative effusions to renal pathology, particularly emphysematous pyelonephritis. Recognition of this entity is critical, as management focuses on treating the underlying source rather than aggressive pleural interventions. This case underscores the importance of considering sympathetic effusion in the differential diagnosis of unexplained exudative pleural effusions—especially in patients with abdominal or retroperitoneal infections—allowing for appropriate, conservative management and avoidance of unnecessary invasive procedures. This abstract is funded by: None
INTRODUCTION: Breast cancer is a leading cause of morbidity and mortality among women in South Asia. Hyperglycemia, a modifiable metabolic risk factor, can significantly contribute to this burden. Quantifying disability-adjusted life years (DALYs) attributable to hyperglycemia can guide targeted prevention strategies. METHODS: We analyzed Global Burden of Disease (GBD) 2021 data to estimate breast cancer DALYs attributable to hyperglycemia among women aged 55 or older in South Asia from 1990 to 2021. Temporal trends were assessed using the annual average percentage change (AAPC), with statistical significance determined by P values. RESULTS: In 1990, the highest DALYs related to breast cancer attributable to hyperglycemia were observed in Pakistan (18.67), followed by India (8.34) and Bhutan (5.51), with the lowest in Bangladesh (5.00). By 2021, DALYs had risen sharply, with Pakistan (44.63) remaining the highest, followed by India (17.07) and Bangladesh (10.27). Bhutan had the lowest rate (9.21). Pakistan also showed the fastest rise (AAPC 2.90; 95% CI, 2.86–2.93), followed by Bangladesh (2.41; 95% CI, 2.35–2.48) and India (2.34; 95% CI, 2.30–2.40), whereas Bhutan increased slowest (1.65; 95% CI, 1.62–1.69). CONCLUSIONS/IMPLICATIONS: Breast cancer-related DALYs attributable to hyperglycemia have risen sharply across South Asia over the past three decades, with Pakistan facing the highest and fastest-growing burden. These findings highlight critical regional disparities and the urgent need for targeted preventive strategies and effective metabolic control to reduce breast cancer morbidity and mortality.
Patients with advanced HIV/AIDS are at high risk for Primary central nervous system lymphoma (PCNSL) due to impaired immune surveillance and HIV-driven B-cell proliferation. While intracranial lesions are well recognized, spinal involvement remains underrecognized due to the scarcity of well-documented reported cases in the current literature. In this report, we describe the case of a 35-year-old male with a new HIV diagnosis who experienced acute bilateral lower extremity weakness and urinary retention during hospitalization for fever, perianal abscess, and urinary tract infection. Initial CD4 count revealed profound immunosuppression, with a CD4 count of less than 20 cells/μL and a viral load of 178,000 copies/mL. Spinal MRI demonstrated an enhancing mass at T2-T3, with surrounding edema extending to C5-C6 and multiple vertebral lesions, while brain MRI was unremarkable. Liver biopsy confirmed Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL), establishing a diagnosis of AIDS-associated systemic lymphoma with secondary central nervous system (CNS) involvement presenting as cauda equina syndrome - a neurosurgical emergency with potential for irreversible paralysis. This case underscores the importance of early, comprehensive spinal imaging in HIV-positive patients with new-onset myelopathy or cauda equina symptoms.
