Introduction: Autoimmune pancreatitis is a rare autoimmune condition associated with pancreatic masses and ductal strictures. Although it has distinct clinical, histological, and morphological findings yet it closely resembles pancreatic malignancy. Therefore, the diagnosis of autoimmune pancreatitis can be a diagnostic challenge. We present a case of an 88-year-old male who presented with a pancreatic mass mimicking pancreatic carcinoma. Case Description/Methods: An 88-year-old male presented to the hospital due to confusion and recurrent falls. He complained of severe lower back pain radiating to the right lower extremity. He had 50 pounds of unintentional weight loss in the last couple of months. He denied bowel or bladder incontinence and saddle anesthesia. The patient's vitals were stable. The exam was benign except for mild abdominal tenderness in the suprapubic region. The initial blood work was within normal limits. The patient urine analysis was positive for leukocyte esterase and nitrites. A computed tomography scan of the abdomen showed an incidental finding of a large pancreatic mass originating from the pancreatic body and extending to the pelvis (1A). The patient was admitted for a urinary tract infection and further workup of the abdominal mass. A positron emission tomography scan showed a hypermetabolic mass involving the proximal pancreatic body and extending to the presacral region (1B). The mass was highly suspicious for malignancy. The alpha-fetoprotein was 2.8 ng/ml, and carcinoembryonic antigen was 2.3 ng/ml. The patient's IgG4 antibodies were negative. He underwent esophagogastroduodenoscopy with endoscopic ultrasound for fine needle biopsy of the mass. The biopsies came back negative for malignant cells but showed atrophic pancreatic tissue with dense fibrosis and lymphoplasmacytic infiltrate (1C). The findings were suggestive of autoimmune pancreatitis and he was started on steroids. A follow-up ERCP and EUS were performed which showed interval resolution of the pancreatic mass. Discussion: Autoimmune Pancreatitis (AP) is a form of chronic pancreatitis with presumed autoimmune etiology. The clinical and radiological presentation closely mimic pancreatic malignancy. Our patient with AP had an unusual presentation as a hypermetabolic pancreatic mass with a high suspicion of malignancy. The prompt diagnosis with appropriate treatment resulted in a favorable outcome. It is essential to differentiate AP from pancreatic malignancy to avoid unnecessary surgeries and procedures.Figure 1.: 1(A): CT scan showing pancreatic mass. 1(B): Pet Scan showing hypermetabolic pancreatic mass. 1(C): Pancreatic ducts with chronic inflammation and fibrosis.

Background Patients with acute hepatitis A virus (HAV) infection are at risk of developing acute kidney injury (AKI) which may result in increased healthcare resource utilization and worse clinical outcomes. We investigated the impact of AKI on healthcare utilization and clinical outcomes in patients hospitalized with acute HAV infection utilizing a large database. Methods We queried the National Inpatient Sample (NIS) 2007-2014 to identify acute HAV infection-related hospitalizations with and without AKI. Primary outcomes were prevalence of AKI and its predictors with secondary outcomes included the mean length of stay (LOS), hospitalization cost and mortality in both groups. Results Out of 68 364 acute HAV infection-related hospitalizations, 47 620 met our study criteria and 7458 (15.7%) had concurrent AKI. HAV patients with AKI were older (62.5 vs. 53.7 years; P value < 0.001). A higher mean LOS (10.03 vs. 5.6 days; P value < 0.001) and mean total hospitalization cost ($27 171.35 vs. $12 790.26; P value < 0.001) were observed in HAV patients with the AKI group. A total of 1032 patients (13.8%) in the AKI group died during the same hospitalization as compared to 681 patients (1.5%) in the non-AKI group, P value < 0.001. AKI in HAV was also found to be an independent predictor of mortality [adjusted odds ratio (aOR), 3.28; 95% confidence interval, 2.23-4.84; P value < 0.001) after adjusting for the confounding factors. Conclusion We found that 15.67% of patients hospitalized with acute HAV had AKI which contributed to increased healthcare utilization and higher mortality which is preventable. Copyright (C) 2021 Wolters Kluwer Health, Inc. All rights reserved.

Introduction: Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhea associated with frequent hospitalizations. Immunosuppressed patients are at higher risk of acquiring CDI due to their weakened immune system and require multiple hospitalizations due to recurrent CDI. The human immunodeficiency virus is one of the most common immunosuppressed states. There is limited literature about CDI in patients with concurrent human immunodeficiency virus (HIV) infection. We aimed to investigate the national estimate of 30 -day readmission rate for CDI in patients with HIV and its burden on healthcare expenditures using a large readmission database. Methods: We queried the national readmission database (NRD) 2017 to identify all the patients hospitalized with Clostridium difficile infection (CDI) in patients with a concomitant diagnosis of HIV using the ICD-10 CM codes. We included all the patients age ≥ 18 years old who had non-elective admissions through January 1st to November 30th for 2017. The primary outcome was all-cause 30-day readmission rates of CDI in HIV patients identifying the most common principal diagnosis for readmission. Secondary outcomes included in-hospital mortality, length of stay (LOS), and total hospitalization charges for index and readmissions. Results: A total of 678 adult patients with principal diagnosis CDI with concurrent HIV were identified in the NRD 2017. Mean age was calculated as 66.28 years, 38.18% of them were females and had Medicare (47.79 %) as the most common insurance. Baseline patients and hospital characteristics for index and 30-day readmission are given in Table 1. A total of 661 (97.49%) patients survived to discharge from the index admission. The 30-day all-cause readmission rate was calculated at 31.46% (n=208). The most common principal diagnosis for readmissions was “clostridium difficile infection” (25.96%), followed by “Human immunodeficiency virus [HIV] diseases” (14.90%) and sepsis (5.76%). The all-cause inpatient mortality (7.21%) was high during the rehospitalization compared to (1.91%) in the index hospitalization. The mean length of stay was also high (7.2 days) in readmissions compared to the index hospitalization (5.9 days). Conclusion: Our study demonstrated that one out of three patients with CDI with HIV get hospitalized again within 30 days. Close outpatient follow-up with appropriate interventions including infection prevention and prolonged duration of treatment can prevent thousands of dollars in healthcare utilizations.Figure 1.: Kaplan-Meier curve for 30-day all-cause readmission among patients with Clostridium Difficile Infection (CDI) and Human Immunodeficiency Virus (HIV).Table 1.: Patient and hospital characteristics for patients presenting with Clostridium Difficile Infection (CDI) and Human Immunodeficiency Virus (HIV).

Introduction: Clostridium difficile infection (CDI) is a common cause of transmissible nosocomial infectious diarrhea, leading to frequent rehospitalization. It is usually associated with immunosuppression, prolonged antibiotic course, gastric suppression, and prolonged hospitalizations. Patients with chronic kidney disease (CKD) are at higher risk for many of these known risk factors for CDI. There is limited literature about CDI in patients with concurrent chronic kidney disease. We aimed to investigate the national estimate of 30-day readmission rate for CDI in patients with CKD and its burden on healthcare expenditures using a large readmission database. Methods: We queried the national readmission database (NRD) 2017 to identify all the patients hospitalized with clostridium difficile infection (CDI) in patients with concomitant chronic kidney disease using the ICD-10 CM codes. We included all the patients age ≥ 18 years old who had non-elective admissions from January 1st to November 30th for 2017. The primary outcome was all-cause 30-day readmission rates of CDI in CKD patients identifying the most common principal diagnosis for readmission. Secondary outcomes included in-hospital mortality, length of stay (LOS), and total hospitalization charges for index and readmissions. Results: A total of 20,202 adult patients with principal diagnosis CDI with concurrent CKD were identified in the NRD 2017 database. Mean age was calculated as 66.26 years, 56.37% of them were females and had Medicare (84.85%) as the most common insurance. Baseline patients and hospital characteristics for index and 30-day readmission are given in Table 1. A total of 19,709 (97.55%) patients survived to discharge from the index admission. The 30-day all-cause readmission rate was calculated at 26.98% (n=5317). The most common principal diagnosis for readmissions was “Enterocolitis due to Clostridium difficile” (17.19%), followed by “Sepsis” (10.58%) and “unspecified Chronic Kidney Disease” (4.02%). The all-cause inpatient mortality (6.88%) was high during the rehospitalization compared to (2.49%) in the index hospitalization. Conclusion: Our study shows that one out of four patients with CDI with pre-existing CKD are readmitted within 30 days which is associated with higher mortality. These patients may require aggressive treatment and a proper discharge follow-up.Figure 1.: Kaplan-Meier curve for 30-day all-cause readmission.Table 1.: Demographics Table.