Human infection with Raoultella ornithinolytica is rare, with only ten cases having been reported previously. This case report describes a local patient diagnosed with community-acquired R. ornithinolytica urinary tract infection in 2014.
Research Interests:
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman... more
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman with primary combined HCC-CC, who had no risk factors for either tumor.
Research Interests:
Human bacteremia with Eggerthella lenta is rare. Upon review of the literature, the largest case series includes only about 100 cases, and optimal management of the condition is still unclear. This case report describes a patient... more
Human bacteremia with Eggerthella lenta is rare. Upon review of the literature, the largest case series includes only about 100 cases, and optimal management of the condition is still unclear. This case report describes a patient diagnosed with E. lenta septicemia due to acute diverticulitis in 2019. This is the first published report of sepsis caused by E. lenta in the state of Hawai'i.
Research Interests:
Research Interests:
Idiopathic thrombocytopenic purpura is an autoimmune disorder causing thrombocytopenia. The authors present the case of a patient who presented with spontaneous bruising. A complete blood cell count revealed the patient was severely... more
Idiopathic thrombocytopenic purpura is an autoimmune disorder causing thrombocytopenia. The authors present the case of a patient who presented with spontaneous bruising. A complete blood cell count revealed the patient was severely thrombocytopenic with a platelet count of 4000. Further evaluation failed to reveal a cause for thrombocytopenia and the patient was subsequently diagnosed with idiopathic thrombocytopenic purpura.
Research Interests:
Seizures are an uncommon but serious complication of hyponatremia which can lead to permanent brain damage and even death. It is recommended that patients with hyponatremic-induced seizures be treated with 3% hypertonic saline, however, a... more
Seizures are an uncommon but serious complication of hyponatremia which can lead to permanent brain damage and even death. It is recommended that patients with hyponatremic-induced seizures be treated with 3% hypertonic saline, however, a rapid rate of correction may result in central pontine myelinolysis (CPM), a severe neurological disorder characterized by mutism, dysarthria, spastic quadriparesis, and pseudobulbar palsy. The patient in this case developed a hyponatremia-induced generalized tonic-clonic seizure which was aborted by rapid therapy with diazepam, followed by hypertonic saline and phenytoin. Subsequent replacement of hypertonic saline with normal saline and salt tabs in combination with phenytoin allowed gradual correction of serum sodium without any subsequent seizures or neurological complications.
Research Interests:
The use of dexamethasone in the management of bacterial meningitis in adults remains controversial. This report illustrates the case of a 27-year-old male with severe meningococcal meningitis and meningococcemia who completely recovered... more
The use of dexamethasone in the management of bacterial meningitis in adults remains controversial. This report illustrates the case of a 27-year-old male with severe meningococcal meningitis and meningococcemia who completely recovered after receiving antibiotics and dexamethasone. In adults with suspected bacterial meningitis, especially in high risk cases, the adjunctive use of dexamethasone may be beneficial.
Research Interests:
The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice,... more
The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice, clay-colored stools, and darkening urine can mimic the presentation of a variety of hepatobiliary illnesses, including cholangiocarcinoma. This case report describes a local patient diagnosed with an extrahepatic cholangiocarcinoma following workup for an acute hepatitis due to ingestion of large quantities of Cascara sagrada.
Research Interests:
Burkholderia cepacia has rarely been reported in Honolulu. Its emergence as a nursing home-acquired pathogen with high mortality rate is concerning. This case report describes a local nursing home patient who was diagnosed with B. cepacia... more
Burkholderia cepacia has rarely been reported in Honolulu. Its emergence as a nursing home-acquired pathogen with high mortality rate is concerning. This case report describes a local nursing home patient who was diagnosed with B. cepacia sepsis in 2012.
Research Interests:
Medicine, Humans, Nursing Homes, Pubmed, Male, and 4 moreSepsis, Burkholderia, Burkholderia Cepacia, and Cross Infection
Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed... more
Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed with community-acquired ESBLEC bacteriuria in 2010.
Research Interests:
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare but serious adverse effect of the selective serotonin reuptake inhibitors (SSRIs). Although many case reports describe this association, few report the effect... more
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare but serious adverse effect of the selective serotonin reuptake inhibitors (SSRIs). Although many case reports describe this association, few report the effect of rechallenge with another SSRI. We present a case of an elderly patient who developed hyponatremia with sertraline and SIADH when rechallenged with fluoxetine.
Research Interests:
Acute generalized pustular psoriasis is an uncommon but dangerous form of psoriasis with a systemic presentation. Acute exacerbation, an early picture of acute generalized pustular psoriasis (AGPP), can be fatal, therefore, early... more
Acute generalized pustular psoriasis is an uncommon but dangerous form of psoriasis with a systemic presentation. Acute exacerbation, an early picture of acute generalized pustular psoriasis (AGPP), can be fatal, therefore, early recognition and systemic therapy is critical. It is an important differential diagnosis of erythroderma. Epidemiology, etiology, diagnosis, and treatment options are discussed in this paper.
Research Interests:
Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.
Research Interests:
An 82-year-old woman who had recently arrived from Japan presented to the emergency department with a 3-day history of abdominal pain that began immediately after she swallowed several pills with a small amount of water. The severe,... more
An 82-year-old woman who had recently arrived from Japan presented to the emergency department with a 3-day history of abdominal pain that began immediately after she swallowed several pills with a small amount of water. The severe, intermittent pain radiated to the patient’s back and worsened with meals. The patient denied chills, nausea, vomiting, coughing, diarrhea, and constipation. She had well-controlled type 2 diabetes mellitus and hypercholesterolemia, and had undergone an appendectomy 50 years earlier.
Research Interests:
Research Interests:
Human anisakiasis, an increasing medical problem in Japan, was recently identified in 7 people in Hawaii. We report an 8th case occurring in an individual who had consumed a large amount of raw squid sushi at a restaurant. The diagnosis... more
Human anisakiasis, an increasing medical problem in Japan, was recently identified in 7 people in Hawaii. We report an 8th case occurring in an individual who had consumed a large amount of raw squid sushi at a restaurant. The diagnosis of anisakiasis in this patient was made after the parasite was identified by X-ray. To our knowledge, radiographic demonstration of the anisakiasis parasite has not been reported in Hawaii previously.
Research Interests:
Mycotic aortic aneurysm associated with suppurative pericardial effusion is a rare and serious clinical phenomenon that is linked with significant morbidity and mortality. We report a case of a 78-year-old man who presented with purulent... more
Mycotic aortic aneurysm associated with suppurative pericardial effusion is a rare and serious clinical phenomenon that is linked with significant morbidity and mortality. We report a case of a 78-year-old man who presented with purulent pericardial effusion with tamponade physiology in association with a progressively enlarging, transverse aortic arch, mycotic aneurysm due to group B streptococci. To our knowledge, this is only the second reported case of this nature. Despite advances in the current era of antibiotics and surgical techniques, early diagnosis and aggressive treatment remain sentinel to successful management of the cardiovascular complications of group B streptococcus bacteremia.
Research Interests:
Research Interests:
Research Interests:
The use of dexamethasone in the management of bacterial meningitis in adults remains controversial. This report illustrates the case of a 27-year-old male with severe meningococcal meningitis and meningococcemia who completely recovered... more
The use of dexamethasone in the management of bacterial meningitis in adults remains controversial. This report illustrates the case of a 27-year-old male with severe meningococcal meningitis and meningococcemia who completely recovered after receiving antibiotics and dexamethasone. In adults with suspected bacterial meningitis, especially in high risk cases, the adjunctive use of dexamethasone may be beneficial.
Research Interests:
Larnygeotracheobronchitis is a common disease of childhood most often associated with infection by parainfluenza virus. Although rare, adult cases have been reported. Adult croup presents similarly to the childhood version; however, the... more
Larnygeotracheobronchitis is a common disease of childhood most often associated with infection by parainfluenza virus. Although rare, adult cases have been reported. Adult croup presents similarly to the childhood version; however, the severity is usually much worse, often leading to hospitalization. Presented is the case of an 80-year-old woman with croup, which is the twelfth reported in the English literature.
Research Interests:
Human bacteremia with Eggerthella lenta is rare. Upon review of the literature, the largest case series includes only about 100 cases, and optimal management of the condition is still unclear. This case report describes a patient... more
Human bacteremia with Eggerthella lenta is rare. Upon review of the literature, the largest case series includes only about 100 cases, and optimal management of the condition is still unclear. This case report describes a patient diagnosed with E. lenta septicemia due to acute diverticulitis in 2019. This is the first published report of sepsis caused by E. lenta in the state of Hawai'i.
Research Interests:
Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed... more
Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed with community-acquired ESBLEC bacteriuria in 2010.
Research Interests:
The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice,... more
The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice, clay-colored stools, and darkening urine can mimic the presentation of a variety of hepatobiliary illnesses, including cholangiocarcinoma. This case report describes a local patient diagnosed with an extrahepatic cholangiocarcinoma following workup for an acute hepatitis due to ingestion of large quantities of Cascara sagrada.
Research Interests:
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman... more
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman with primary combined HCC-CC, who had no risk factors for either tumor.
Research Interests:
Chylothorax occurring in the setting of a lymphoma or a surgical procedure involving the area around the thoracic duct is a well-known phenomenon. Less common is the occurrence of chylothorax in conjunction with cirrhosis of the liver.... more
Chylothorax occurring in the setting of a lymphoma or a surgical procedure involving the area around the thoracic duct is a well-known phenomenon. Less common is the occurrence of chylothorax in conjunction with cirrhosis of the liver. Due to the paucity of data, it is uncertain if chylothorax is an associated or an independent sign of cirrhosis. The case reports in the literature favor the former, as demonstrated in this case of a patient with cirrhosis of the liver who developed a chylothorax.
Research Interests:
Seizures are an uncommon but serious complication of hyponatremia which can lead to permanent brain damage and even death. It is recommended that patients with hyponatremic-induced seizures be treated with 3% hypertonic saline, however, a... more
Seizures are an uncommon but serious complication of hyponatremia which can lead to permanent brain damage and even death. It is recommended that patients with hyponatremic-induced seizures be treated with 3% hypertonic saline, however, a rapid rate of correction may result in central pontine myelinolysis (CPM), a severe neurological disorder characterized by mutism, dysarthria, spastic quadriparesis, and pseudobulbar palsy. The patient in this case developed a hyponatremia-induced generalized tonic-clonic seizure which was aborted by rapid therapy with diazepam, followed by hypertonic saline and phenytoin. Subsequent replacement of hypertonic saline with normal saline and salt tabs in combination with phenytoin allowed gradual correction of serum sodium without any subsequent seizures or neurological complications.
Research Interests:
Burkholderia cepacia has rarely been reported in Honolulu. Its emergence as a nursing home-acquired pathogen with high mortality rate is concerning. This case report describes a local nursing home patient who was diagnosed with B. cepacia... more
Burkholderia cepacia has rarely been reported in Honolulu. Its emergence as a nursing home-acquired pathogen with high mortality rate is concerning. This case report describes a local nursing home patient who was diagnosed with B. cepacia sepsis in 2012.
Research Interests:
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Research Interests:
Human bacteremia with Eggerthella lenta is rare. Upon review of the literature, the largest case series includes only about 100 cases, and optimal management of the condition is still unclear. This case report describes a patient... more
Human bacteremia with Eggerthella lenta is rare. Upon review of the literature, the largest case series includes only about 100 cases, and optimal management of the condition is still unclear. This case report describes a patient diagnosed with E. lenta septicemia due to acute diverticulitis in 2019. This is the first published report of sepsis caused by E. lenta in the state of Hawai'i.
Research Interests:
Acute generalized pustular psoriasis is an uncommon but dangerous form of psoriasis with a systemic presentation. Acute exacerbation, an early picture of acute generalized pustular psoriasis (AGPP), can be fatal, therefore, early... more
Acute generalized pustular psoriasis is an uncommon but dangerous form of psoriasis with a systemic presentation. Acute exacerbation, an early picture of acute generalized pustular psoriasis (AGPP), can be fatal, therefore, early recognition and systemic therapy is critical. It is an important differential diagnosis of erythroderma. Epidemiology, etiology, diagnosis, and treatment options are discussed in this paper.
Research Interests:
Acute kidney injury, Medicine, Humans, Shock, Male, and 3 morePsoriasis, Aged, and Medical and Health Sciences
A 49-year-old man presents for a routine examination. He has a 15-year history of essential hypertension and a 7-year history of hypercholesterolemia and type 2 diabetes mellitus.
Research Interests:
Talc is a commonly used sclerosing agent for pleurodesis. However, there have been recent reports of a number of complications associated with the use of talc. Although there is significant data regarding the respiratory complications... more
Talc is a commonly used sclerosing agent for pleurodesis. However, there have been recent reports of a number of complications associated with the use of talc. Although there is significant data regarding the respiratory complications associated with talc, reports of bleeding complications are extremely rare. We present the case of a 78 year-old man who was treated with talc pleurodesis for recurrent pleural effusion and subsequently developed a massive hemothorax, a rare complication.
Research Interests:
Humans, Male, Aged, Pleural Effusion, TALC, and 4 morePLEURODESIS, Pleurisy, Hemothorax, and Medical and Health Sciences
Human infection with Raoultella ornithinolytica is rare, with only ten cases having been reported previously. This case report describes a local patient diagnosed with community-acquired R. ornithinolytica urinary tract infection in 2014.
Research Interests:
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman... more
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman with primary combined HCC-CC, who had no risk factors for either tumor.
Research Interests:
... Pheochromocytoma and Papillary Carcinoma in a Man With Hypertension and Acute Cholecystitis. By ASHLEE C. NEKOBA, MD JINICHI TOKESHI, MD University of Hawaii John A. Burns School of Medicine. RONALD KURODA, MD Orlando Health, Orlando,... more
... Pheochromocytoma and Papillary Carcinoma in a Man With Hypertension and Acute Cholecystitis. By ASHLEE C. NEKOBA, MD JINICHI TOKESHI, MD University of Hawaii John A. Burns School of Medicine. RONALD KURODA, MD Orlando Health, Orlando, Fla. ...
Research Interests:
Medicine and Consultant
Burkholderia cepacia has rarely been reported in Honolulu. Its emergence as a nursing home-acquired pathogen with high mortality rate is concerning. This case report describes a local nursing home patient who was diagnosed with B. cepacia... more
Burkholderia cepacia has rarely been reported in Honolulu. Its emergence as a nursing home-acquired pathogen with high mortality rate is concerning. This case report describes a local nursing home patient who was diagnosed with B. cepacia sepsis in 2012.
Research Interests:
Seizures are an uncommon but serious complication of hyponatremia which can lead to permanent brain damage and even death. It is recommended that patients with hyponatremic-induced seizures be treated with 3% hypertonic saline, however, a... more
Seizures are an uncommon but serious complication of hyponatremia which can lead to permanent brain damage and even death. It is recommended that patients with hyponatremic-induced seizures be treated with 3% hypertonic saline, however, a rapid rate of correction may result in central pontine myelinolysis (CPM), a severe neurological disorder characterized by mutism, dysarthria, spastic quadriparesis, and pseudobulbar palsy. The patient in this case developed a hyponatremia-induced generalized tonic-clonic seizure which was aborted by rapid therapy with diazepam, followed by hypertonic saline and phenytoin. Subsequent replacement of hypertonic saline with normal saline and salt tabs in combination with phenytoin allowed gradual correction of serum sodium without any subsequent seizures or neurological complications.
Research Interests:
The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice,... more
The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice, clay-colored stools, and darkening urine can mimic the presentation of a variety of hepatobiliary illnesses, including cholangiocarcinoma. This case report describes a local patient diagnosed with an extrahepatic cholangiocarcinoma following workup for an acute hepatitis due to ingestion of large quantities of Cascara sagrada.
Research Interests:
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare but serious adverse effect of the selective serotonin reuptake inhibitors (SSRIs). Although many case reports describe this association, few report the effect... more
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare but serious adverse effect of the selective serotonin reuptake inhibitors (SSRIs). Although many case reports describe this association, few report the effect of rechallenge with another SSRI. We present a case of an elderly patient who developed hyponatremia with sertraline and SIADH when rechallenged with fluoxetine.
Research Interests:
Phytobezoars commonly develop in the distal small bowel, where the lumen is narrow. Prevalence is higher after partial gastric resection.
Research Interests:
Mycotic aortic aneurysm associated with suppurative pericardial effusion is a rare and serious clinical phenomenon that is linked with significant morbidity and mortality. We report a case of a 78-year-old man who presented with purulent... more
Mycotic aortic aneurysm associated with suppurative pericardial effusion is a rare and serious clinical phenomenon that is linked with significant morbidity and mortality. We report a case of a 78-year-old man who presented with purulent pericardial effusion with tamponade physiology in association with a progressively enlarging, transverse aortic arch, mycotic aneurysm due to group B streptococci. To our knowledge, this is only the second reported case of this nature. Despite advances in the current era of antibiotics and surgical techniques, early diagnosis and aggressive treatment remain sentinel to successful management of the cardiovascular complications of group B streptococcus bacteremia.
Research Interests:
Idiopathic thrombocytopenic purpura is an autoimmune disorder causing thrombocytopenia. The authors present the case of a patient who presented with spontaneous bruising. A complete blood cell count revealed the patient was severely... more
Idiopathic thrombocytopenic purpura is an autoimmune disorder causing thrombocytopenia. The authors present the case of a patient who presented with spontaneous bruising. A complete blood cell count revealed the patient was severely thrombocytopenic with a platelet count of 4000. Further evaluation failed to reveal a cause for thrombocytopenia and the patient was subsequently diagnosed with idiopathic thrombocytopenic purpura.
Research Interests:
Chylothorax occurring in the setting of a lymphoma or a surgical procedure involving the area around the thoracic duct is a well-known phenomenon. Less common is the occurrence of chylothorax in conjunction with cirrhosis of the liver.... more
Chylothorax occurring in the setting of a lymphoma or a surgical procedure involving the area around the thoracic duct is a well-known phenomenon. Less common is the occurrence of chylothorax in conjunction with cirrhosis of the liver. Due to the paucity of data, it is uncertain if chylothorax is an associated or an independent sign of cirrhosis. The case reports in the literature favor the former, as demonstrated in this case of a patient with cirrhosis of the liver who developed a chylothorax.
Research Interests:
Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed... more
Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed with community-acquired ESBLEC bacteriuria in 2010.
Research Interests:
May 2011 Dear Brad: I have taught generations of medical students, sons and daughters of other fathers, for over three decades. For some reason I failed to talk to you about what I thought was very important as a physician and a person.... more
May 2011 Dear Brad: I have taught generations of medical students, sons and daughters of other fathers, for over three decades. For some reason I failed to talk to you about what I thought was very important as a physician and a person. As you are launching a new life as a physician I would like to share my inner thoughts and principles that I have lived by in a form of an open letter. It is called five virtues. There are many variations of five virtues quoted in the literature and the concept is nothing new. It goes back to an ancient Chinese philosopher.1 The idea was also used as an instrument to educate the children of samurai the bushido,2 the way of warrior, in Japan prior to Meiji Restoration. Here, I include Jin, Gi, Rei, Chi, and Shin with my personal interpretations that guided me in the way of medicine. Jin is the first virtue. Jin3 is compassion or empathy to fellow human beings as its kanji character suggests. Incidentally, my first name, Jinichi4 means Jin comes first....