ST-segment elevation in acute cholecystitis with uncontrolled hyperthyroidism

SYNOPSIS: A variety of non-cardiac conditions have been reported to present with ischemic heart disease clinically and electrocardiographically like cholecystitis which leads to nonspecific T-wave inversions or ST-segment depressions, rarely  it  leads  to  ST-segment  elevation.CLINICAL PRESENTATION: We  report  a  case  of  a  58-year-old,male,  hypertensive,  diabetic,  and  with  hyperthyroidism on  medication.  Patient  presents  with  two  weeks history of  epigastric  pain  associated  with  nausea  and  vomiting.Symptoms spontaneously resolved until one day prior to admission  patient  developed  persistent  abdominal  pain.Patient  was  seen  at  a  local  hospital  wherein  work-up was  done  which  showed  leukocytosis  on  CBC, hydrops of  gallbladder  on  ultrasound. Further work-up were anteroseptal wall ST elevation on ECG with negative cardiac enzymes. Patient was advised transfer to our institution.  PHYSICAL FINDINGS: Pertinent  Physical  exam  includes tachycardia, epigastric tenderness and positive Murphy's sign. During the course, patient developed fever and jaundice.  LABORATORY WORK-UP: Repeat CBC still showed leukocytosis with  neutrophilia.  Repeat  electrocardiogram  showed anteroseptal  wall  ST  elevation  with  negative  Troponin.Echocardiogram showed adequate ejection fraction and adequate  wall  motion  contractility.Thyroid  function  test showed  increased  FT4  and  decreased  TSH.TREATMENT: Patient was initially started with acute coronary syndrome  regimen.  Antibiotics  were  initiated  and  anti-thyroid and anti-diabetes drugs were adjusted accordingly.There  was  noted  progressive  abdominal  pain; hence, patient  was  referred  to  surgery.  Patient  was  cardio-pulmonary  and  endocrinologically  prepared  and  cleared  for  the  procedure.    Patient  tolerated  the  procedure.OUTCOME: Patient  was  discharged  improved  with  noted improvement  of  the  electrocardiogram.

Priapism as a rare presentation of chronic myelogenous leukemia

BACKGROUND: Priapism is a rare complication seen in one to five percent of adult leukemic patients. The word 'Priapism' is related to Priapus, the Greek and Roman God of procreation whose symbol was an erect phallus. CLINICAL PRESENTATION: The patient is a 22-year-old male with no known co-morbidities presenting with one month intermittent, unstimulated, painful penile erection with no other associated symptoms which resolves spontaneously, until nine hours prior to admission when symptoms recurred and persisted. Patient had no history of trauma and no drug intake. PHYSICAL FINDINGS: Patient was awake, in pain and tachycardic. There was note of pallor and splenomegaly. The penis was erect, firm, swollen and tender with superficial venous engorgement. The rest of the physical examination was unremarkable. LABORATORY WORK UP: Complete blood count showed anemia and leukocystosis. Peripheral blood smear revealed markedly increased white blood cells with predominance of mature and immature cells belonging to granulocytic series. There was splenomegaly on ultrasound. Genetic testing showed an abnormal male karyotype of 46 chromosomes including translocation (9;22). TREATMENT: Corpora cavernosa aspiration was done. Terbutaline was given. Patient was started and maintained on hydroxyurea and presently enrolled in Imitanib study. OUTCOME: There was resolution of priapism after the corpus cavernosa aspiration and initiation of hydroxyurea and the white blood cell count had decreased after initiation of hydroxyurea.