Keratolysis Associated with Methamphetamine Use - Incidental Diagnosis of Corneal Melt in a Patient with Acute Methamphetamine Intoxication.

CASE PRESENTATION: A 38-year-old male presented to the emergency department with methamphetamine-induced agitation. Physical exam showed clouding of the left cornea, with gelatinous appearance and associated conjunctivitis, consistent with corneal melt, or keratolysis. DISCUSSION: Keratolysis is dissolution of the corneal stroma that can lead to corneal ulceration and vision loss. Smoking stimulants has been shown to be associated with this pattern of ocular injury, although this is a relatively rare presentation. Acute keratolysis is a unique complication of methamphetamine preparation and ingestion via smoking that can lead to corneal ulceration and loss of vision.

Pediatric Herpes Zoster.

A 10-year-old male vaccinated against varicella had developed left-sided rashes on his thoracic region in single dermatomal distribution, which is consistent with herpes zoster. Although herpes zoster is uncommon in children, especially with the current vaccination regimen, this case report serves as a reminder to consider it in one's differential diagnoses, even in the immunocompetent, fully immunized pediatric patient. This is a case report of a previously healthy, fully vaccinated child who developed herpes zoster.

Paraspinal Abscess in a Two-year-old Female.

A paraspinal abscess is an uncommon condition frequently diagnosed late due to equivocal symptoms, which can lead to increased morbidity and mortality. Commonly associated risk factors include prior invasive spinal procedures, diabetes mellitus, trauma, chronic steroid use, malnutrition, intravenous drug use and an immunocompromised state. Pediatric paraspinal abscesses are not well documented in the literature. We report a case of a two-year-old female presenting with fevers, lower back pain, and decreased oral intake ultimately diagnosed with isolated lumbar paraspinal abscess. The patient underwent an ultrasound-guided percutaneous drainage of the abscess, subsequently improving, and was discharged within 48 hours of presentation.

Acute Finger Ischemia in an Elderly Male without Risk Factors for Hypercoagulability.

Literature on ulnar artery thrombosis and acute finger ischemia is scant and usually related to underlying hypercoagulable or occlusive states, such as atrial fibrillation, thrombangiitis obliterans, vasospasm, trauma, and neurovascular compression at the root of the upper limb. An elderly hypertensive male without an underlying hypercoagulable state, and in otherwise good health, presented to our emergency department with acute multi-finger ischemia, and ulnar artery and palmar arch thromboses. Given his innocuous history, this case demonstrates the importance of maintaining acute arterial thrombosis on the differential for hand pain despite the obvious propensity toward mechanical injuries in the extremities.

Acquired Pediatric Right Diaphragmatic Hernia Following Automatic Implantable Cardioverter-defibrillator Placement.

Diaphragmatic hernias are an uncommon occurrence in the pediatric population; however, they can cause significant morbidity and mortality if the diagnosis is missed or delayed. This case discusses the radiographic and clinical exam findings of a one-year-old patient with this pathology.

Retained Catheter in the Aorta.

Due to the recent increase in endovascular procedures, retained foreign bodies such as stents and catheters in vasculature have become a common and serious complication. Treatments for these complications vary depending on the acuity and stability of the foreign body in the vessel. We discuss a rare case of an adult found to have an incidental retained umbilical artery catheter in the aorta.

An Unusual Case of Unilateral Papilledema.

Neuroretinitis from neurosyphilis is an uncommon finding in previously healthy young individuals. A 37-year-old presented with three days of painless, unilateral vision loss with an associated diffuse erythematous non-pruritic truncal rash. Physical exam demonstrated vision loss in the left eye. Fundoscopic exam showed unilateral peripapillary hemorrhage, papilledema and venous engorgement. Labs showed positive syphilis antibody qualitative. Magnetic resonance imaging demonstrated 12 millimeters of high right frontal lobe cerebrospinal fluid density. The patient was treated with benzylpenicillin and within 18 hours had improvement of his vision.

Steal Phenomenon with Tonsillar Arteriovenous Malformation.

Cranial vascular malformations can cause symptoms of headache, stroke, transient ischemic attack, or other cerebrovascular disorders due to steal phenomenon. Subclavian steal phenomenon is a localized change in cerebral perfusion from a cranial arteriovenous malformation (AVM). We present the only recorded case of a tonsillar AVM causing a transient ischemic attack due to steal phenomenon.