Person: Kroshinsky, Daniela
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Kroshinsky
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Daniela
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Kroshinsky, Daniela
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Publication Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis(American Medical Association (AMA), 2017) Weng, Qing Yu; Raff, Adam; Cohen, Jeffrey Marcus; Gunasekera, Nicole; Okhovat, Jean-Phillip; Vedak, Priyanka; Joyce, Cara; Kroshinsky, Daniela; Mostaghimi, ArashQuestion What is the national health care burden of misdiagnosed lower extremity cellulitis in patients admitted to the hospital from the emergency department? Findings In this cross-sectional study that included 259 patients, 30% were misdiagnosed with cellulitis, of which 85% did not require hospitalization and 92% received unnecessary antibiotics. Combining these findings with previously published data, cost estimates, and and projections indicate that cellulitis misdiagnosis leads to 50 000 to 130 000 unnecessary hospitalizations in the United States and $195 million to $515 million in avoidable health care spending annually. Meaning Misdiagnosis of lower extremity cellulitis is common and may lead to unnecessary patient morbidity and considerable health care spending.Publication A 92-Year-Old Male with Eosinophilic Asthma Presenting with Recurrent Palpable Purpuric Plaques(S. Karger AG, 2018) Negbenebor, Nicole A.; Khalifian, Saami; Foreman, Ruth; Kroshinsky, DanielaChurg-Strauss syndrome or eosinophilic granulomatosis with polyangiitis is a systemic vasculitis affecting the small and medium-sized vasculature. It is commonly associated with asthma and eosinophilia. Most patients are diagnosed at around the age of 40. We report a case of biopsy-confirmed Churg-Strauss syndrome in a 92-year-old male with a history of eosinophilic asthma and peripheral eosinophilia who was later diagnosed with Churg-Strauss syndrome.Publication A 25-Year-Old Male with Orogenital Ulcers, Rash, and Difficulty Swallowing(S. Karger AG, 2017) Ko, Lauren; Alloo, Allireza; Lin, William; Hoang, Mai; Kroshinsky, DanielaA 25-year-old otherwise healthy male presented with new-onset odynophagia, rash, and orogenital ulcers. Despite treatment with antibiotics for presumed bacterial pharyngitis, the patient remained symptomatic, with abnormal vital signs and laboratory values. Upon dermatology consultation and histopathologic correlation, he was diagnosed with Behçet disease. Behçet disease is a rare rheumatologic condition that presents with recurrent oral ulcers and varying degrees of ophthalmic, neurologic, cardiac, and vascular disease. Given its protean nature, the treatment of Behçet disease is tailored to the patient's presentation and severity of organ involvement. Following treatment with colchicine and prednisone, the patient's symptoms improved rapidly.Publication A 53-Year-Old Male with Relapsed Diffuse Large B-Cell Lymphoma on Chemotherapy with a New Leg Lesion(S. Karger AG, 2017) Shi, Connie; Robinson, Sarah; LaChance, Avery; Mihm Jr., Martin C.; Kroshinsky, DanielaPatients with underlying malignancy who develop new skin findings while acutely ill often require skin biopsy for histologic evaluation and/or culture to reach a diagnosis. Here, we present the case of a 53-year-old male with relapsed diffuse large B-cell lymphoma on chemotherapy who developed new skin lesions on the leg. On exam, there were 2 nickel-sized, erythematous to violaceous round plaques with central necrotic cores on the right lower leg with relatively nonspecific clinical features for which the initial differential diagnosis was broad. Consensus on a diagnosis was reached upon histologic evaluation of his skin biopsy in the context of his clinical setting. This diagnosis led to a change in treatment plan, with subsequent clinical improvement.Publication A 71-Year-Old Female with Myocardial Infarction and Long-Standing Ulcers on the Thigh(S. Karger AG, 2017) De Flammineis, Eduardo; Mulvaney, Patrick; Kraft, Stefan; Mihm Jr., Martin C.; Das, Shinjita; Kroshinsky, DanielaCalciphylaxis is most commonly encountered in patients with end-stage renal disease; however, it is increasingly observed in nonuremic patients as well. It is important to consider and diagnose nonuremic calciphylaxis early, as prompt treatment and mitigation of associated risk factors is essential to improve long-term outcomes for these patients. Here, we present the case of a 71-year-old woman with atrial fibrillation on warfarin, but without renal disease, who presented with two long-standing ulcers on her thigh and was diagnosed with the aid of biopsy with calciphylaxis. We review the existing literature on the subject and offer this case as a representative report of a clinicopathologic correlation for this disorder.Publication A 65-Year-Old Male with Primary Central Nervous System Diffuse Large B-Cell Lymphoma on Nivolumab with Oral Mucositis and Targetoid Plaques(S. Karger AG, 2017) Cao, Severine; Rohani, Pooyan; Nazarian, Rosalynn; Kroshinsky, DanielaBackground/Aims The development of programmed cell death-1 (PD-1) inhibitors has greatly improved patient outcomes in the treatment of a variety of advanced malignancies. These novel immunotherapies are not without adverse effects, the most common of which are dermatologic. Methods: We report our experience with an atypical erythema multiforme-like eruption in a patient with primary central nervous system diffuse large B-cell lymphoma treated with nivolumab. Results: The patient presented with oral mucositis and scattered erythematous papules which progressed to targetoid purpuric plaques with hyperkeratotic centers. Histopathology demonstrated interface dermatitis with dyskeratotic keratinocytes and pigment incontinence. The patient experienced improvement of the eruption with discontinuation of nivolumab and on systemic and topical glucocorticoids. Conclusion: As PD-1 inhibitors become more widely used in the treatment of advanced malignancies, the early recognition and treatment of rare dermatologic toxicities remain of great importance.Publication A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study(Elsevier BV, 2017) Raff, Adam; Weng, Qing Yu; Cohen, Jeffrey M.; Gunasekera, Nicole; Okhovat, Jean-Phillip; Vedak, Priyanka; Joyce, Cara; Kroshinsky, Daniela; Mostaghimi, ArashBackground Cellulitis has many clinical mimickers (pseudocellulitis), which leads to frequent misdiagnosis. Objective To create a model for predicting the likelihood of lower extremity cellulitis. Methods A cross-sectional review was performed of all patients admitted with a diagnosis of lower extremity cellulitis through the emergency department at a large hospital between 2010 and 2012. Patients discharged with diagnosis of cellulitis were categorized as having cellulitis, while those given an alternative diagnosis were considered to have pseudocellulitis. Bivariate associations between predictor variables and final diagnosis were assessed to develop a 4-variable model. Results In total, 79 (30.5%) of 259 patients were misdiagnosed with lower extremity cellulitis. Of the variables associated with true cellulitis, the 4 in the final model were asymmetry (unilateral involvement), leukocytosis (white blood cell count ≥10,000/uL), tachycardia (heart rate ≥90 bpm), and age ≥70 years. We converted these variables into a points system to create the ALT-70 cellulitis score as follows: Asymmetry (3 points), Leukocytosis (1 point), Tachycardia (1 point), and age ≥70 (2 points). With this score, 0-2 points indicate ≥83.3% likelihood of pseudocellulitis, and ≥5 points indicate ≥82.2% likelihood of true cellulitis. Limitations Prospective validation of this model is needed before widespread clinical use. Conclusion Asymmetry, leukocytosis, tachycardia, and age ≥70 are predictive of lower extremity cellulitis. This model might facilitate more accurate diagnosis and improve patient care.