Activity

ANCA-associated vasculitis is a multiorgan autoimmune inflammatory disease that has a heterogeneous clinical presentation. Our case report provides additional evidence supporting the association between granulomatosis with polyangiitis and myositis. In our patient with proximal muscle weakness and pain, a normal creatine kinase and lack of antibodies to muscular fiber units ruled out primary myositis. Distinct magnetic resonance imaging of the brain within the deep gray matter in addition to positive serologies were consistent with a diagnosis of granulomatosis with polyangiitis. ANCA-associated vasculitis, specifically granulomatosis with polyangiitis, may be overlooked if musculoskeletal manifestations are the presenting symptoms. Prompt and aggressive treatment prevented this patient from experiencing multiorgan failure.Mauriac syndrome is an uncommon clinical condition arising in the setting of poorly controlled type 1 diabetes mellitus. Clinical features include hepatomegaly and liver abnormalities indistinguishable from nonalcoholic fatty liver disease. Early diagnosis and management are essential, as Mauriac syndrome is reversible.Sorafenib, an oral chemotherapeutic agent used in the treatment of solid tumors, is associated with a variety of adverse cutaneous drug reactions in up to 90% of patients. Infrequently, delayed-type hypersensitivity reactions such as erythema multiforme occur. This case describes a child treated with sorafenib for a retrosternal desmoid tumor who developed widespread erythema multiforme across his extremities, trunk, face, and mucosal membranes.Flecainide is an antiarrhythmic agent indicated for patients with supraventricular arrhythmias without ischemic or structural heart disease. Flecainide toxicity is a rare condition in which patients may present with bradycardia, widening of QRS, PR prolongation, ventricular tachycardia, syncope, malaise, dizziness, visual disturbance, nausea, vomiting, and/or lethargy. It carries an associated mortality rate of approximately 10%. Herein, we describe the course of a patient who experienced flecainide toxicity in the setting of renal and liver failure.This case describes a 48-year-old Hispanic man with a history of glioblastoma multiforme on active chemotherapy treatment and corticosteroids who presented to the emergency room with complaints of cough, fever, chills, fatigue, confusion, and somnolence. Workup yielded evidence of disseminated cryptococcal disease. The case highlights the importance of a broad differential in patients with a history of being immunocompromised.Intravascular lymphoma is an uncommon subtype of B-cell lymphoma with neoplastic cells limited to the lumen of small blood vessels. We report a case of a 52-year-old man who presented with constitutional symptoms and rapidly progressive dementia. He was found to have diffuse leptomeningeal and faint parenchymal enhancement on magnetic resonance imaging and was subsequently diagnosed with intravascular lymphoma following a brain biopsy. He responded remarkably well to systemic and intrathecal chemotherapy. The diagnosis and treatment of intravascular lymphoma have been guided by a few case reports and are largely based on expert opinion.This case report describes a 52-year-old man who presented with 2 weeks of left lower quadrant pain and bloody stool. Computed tomography revealed a 4 cm, fat-density mass acting as a lead point for intussusception of the sigmoid colon. Surgical resection was successfully performed, and histologic evaluation confirmed the diagnosis of a pedunculated colonic lipoma. Intussusception of the colon is uncommon in adults and is often associated with malignancy, but other nonmalignant causes such as a lipoma may also present similarly with obstructive symptoms, bloody stool, and/or intermittent abdominal pain. Colonic lipoma should be considered in the differential of a patient with clinical or imaging evidence of intussusception, with primary resection leading to an excellent prognosis.Jejunal atresia is a well-known congenital malformation attributed to in utero ischemic events. Heterotopic gastric mucosa (HGM), or gastric tissue present in a location other than the stomach, is a much rarer congenital anomaly and is generally found in the esophagus or within a Meckel’s diverticulum. Identifying both within the same pathologic specimen is truly rare. This report outlines a case of jejunal atresia wherein HGM was identified within postoperative pathology evaluation of the specimen. An early episode of restenosis at the anastomosis prompted operative re-exploration, in which additional HGM was found within the specimen.Meckel’s diverticulum is a true diverticulum caused by the incomplete obliteration of the vitelline duct during gestation. It is the most common congenital malformation of the gastrointestinal tract. Meckel’s diverticulum is a rare presentation in adults, especially because symptomatic patients present in early childhood. selleck We present a 57-year-old woman with symptomatic iron deficiency after recent nonsteroidal anti-inflammatory use. After normal upper and lower endoscopy, a capsule endoscopy showed an oozing polyp in the distal ileum. The small bowel was surgically resected, and histopathology confirmed Meckel’s diverticulum as the cause of her small bowel bleeding. Rare causes such as Meckel’s diverticulum should be kept in mind in the differential diagnosis for patients with suspected small bowel bleeding.Several case reports have suggested that COVID-19 may increase the risk of gastrointestinal perforation. We report a case of a gastrointestinal perforation developing in a COVID-19 patient who presented due to injuries from a motor vehicle accident. On admission, the patient had elevated white blood cells, with neutrophilia and lymphopenia. Histological examination of tissue surrounding the perforation revealed extensive infiltration of lymphocytes and plasma cells into the intestinal mucosa. These findings are consistent with SARS-CoV-2 infection. However, further pathophysiological studies are needed to assess the mechanisms by which COVID-19 may damage the gastrointestinal mucosa leading to gastrointestinal perforation.