Case 1: New, acute onset ascites and abdominal pain

Portal vein thrombosis often does not have remarkable LFT changes.

Triple-phase CT - indicated when?

Malignant culture-negative neutrocytic ascites - case reports in 2017 and 2019, no clear guidance for management

Case 2:

beta-D-glucan - invasive fungal infx test, takes time to result (how long? how good?)

GMS stain - identifies many kinds of fungi, pathologists mostly report morphology with possibilities that require clinical correlation https://cmr.asm.org/content/24/2/247

pneumocystis jirovecii pneumonia in non-HIV infx pts

Stem cell tx, solid organ tx, heme malignancies, high-dose steroids, immunosuppression

Risk for solid organ tx depends on tx, ?mostly d/t degree of immunosuppression

Presents with nonspecific sx: dysnpea, fever, dry cough, hypoxia out of proportion to level of distress (this last point a personal obs from presenter - mb worth a study!)

Definitive dx with GMS from sputum or BAL, direct fluorescent antibody, PCR (PCR may have higher diagnostic yield)

Presumptive dx (may be too hypoxic for bronchoscopy): increased beta-D-glucan, radiographic findings, clinical features, possibly increased LDH, and r/o other fungal causes

Firstline tx: TMP-SMX 15-20mg/kg, desensitize if minor allergy+steroids if severe (low PaO2 or requiring supplemental O2)

Secondline tx: clindamycin+primaquine; clindamycin+primaquine or TMP + dapsone if moderate; 21 total days.