Pleural plasmacytomas in a patient with multiple myeloma relapse.

Extramedullary plasmacytoma with pleural involvement in the setting of relapsed multiple myeloma (MM) is a rare yet serious condition, which is associated with an adverse prognosis. This report describes a patient with MM who was in complete remission but relapsed with multiple pleural plasmacytomas. The diagnosis was established in a timely manner and the patient was started on appropriate treatment.

Gastrointestinal Stromal Tumor: An Uncommon but Serious Cause of Gastrointestinal Bleeding.

Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract that can sometimes present as a gastrointestinal bleeding source. This report describes a patient presented with upper GI bleeding secondary to a gastric GIST, which was initially detected on endoscopy. The patient underwent surgical resection of the tumor and was started on adjuvant chemotherapy with imatinib. The patient's postoperative course was complicated by an esophageal leak requiring re-exploratory laparotomy and esophageal stent placement. The stent was removed 5 weeks later and the patient remained stable for discharge after 60 days of inpatient care.

A Fatal Case of Hypertriglyceridemia-Induced Acute Pancreatitis in a Patient With Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) with coexisting hypertriglyceridemia-induced acute pancreatitis is a rare yet potentially life-threatening condition. This report describes a patient with no history of diabetes who presented with DKA and coexisting acute pancreatitis secondary to severe hypertriglyceridemia. The patient did not respond to standard DKA management or plasmapheresis, developed acute respiratory distress syndrome (ARDS), and eventually expired.

Adalimumab-Induced Thrombocytopenia in a Patient With Hidradenitis Suppurativa.

Adalimumab-induced thrombocytopenia is a rarely occurring condition that may present with hemorrhagic manifestations. This report describes a case of a patient who presented with severe, symptomatic thrombocytopenia while on adalimumab for the treatment of hidradenitis suppurativa. The patient responded to treatment with steroids, intravenous immunoglobulin (IVIG), and platelet transfusion, in addition to discontinuation of adalimumab.

The Levels of Lactate, Troponin, and N-Terminal Pro-B-Type Natriuretic Peptide Are Predictors of Mortality in Patients with Sepsis and Septic Shock: A Retrospective Cohort Study.

BACKGROUND Serum lactate, troponin, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been proposed to be useful prognostic indicators in patients with sepsis and septic shock. This study aimed to evaluate the predictive ability of these biomarkers and assess how their prognostic utility may be improved by using them in combination. MATERIAL AND METHODS A retrospective review of the medical records of 1242 patients with sepsis and septic shock who were admitted to the Richmond University Medical Center between June 1, 2018, and June 1, 2019, was carried out; 427 patients met the study criteria and were included in the study. The primary outcome measures included 30-day mortality, APACHE II scores, length of hospital stay, and admission to the Medical Intensive Care Unit (MICU). RESULTS High levels of lactate (>4 mmol/L), troponin (>0.45 ng/mL), and NT-proBNP (>8000 pg/mL) were independent predictors of 30-day mortality, with an adjusted odds ratio of mortality being 3.19 times, 2.13 times, and 2.5 times higher, respectively, compared with corresponding reference groups, at 95% confidence intervals. Elevated levels of lactate, troponin, and NT-proBNP were associated with 9.12 points, 7.70 points, and 8.88 points in higher APACHE II scores, respectively. Only elevated troponin levels were predictive of a longer length of hospital stay. In contrast, elevated lactate and troponin were associated with an increased chance of admission to the MICU. CONCLUSIONS Elevated levels of serum lactate, troponin, and NT-proBNP are independent predictors of mortality and higher APACHE II scores in patients with sepsis and septic shock.

Left Ventricular Free Wall Rupture in Broken-Heart Syndrome: A Fatal Complication.

Takotsubo cardiomyopathy is usually a transient condition and is treated conservatively. It is rarely associated with ventricular free wall rupture, a fatal complication of the disease described in this report. Cardiothoracic surgery performed emergent ventricular wall repair; however, treatment was unsuccessful, and the patient expired.

Cavernous Hemangioma: A Rare Cause of Massive Lower Gastrointestinal Bleeding.

Due to their rarity, intestinal hemangiomas are not commonly considered as a cause of gastrointestinal (GI) bleeding. This report describes a patient who presented with massive, recurrent lower GI bleeding secondary to a cavernous hemangioma of the small intestine. The source of GI bleeding could not initially be identified despite using numerous diagnostic modalities. The lesion was eventually revealed on diagnostic laparoscopy and small bowel resection was performed.

Tuberculosis in an Immunocompetent Immigrant Patient.

Peritoneal tuberculosis (TB) is a rare medical condition in developed nations like the United States, and it is uncommon to observe this condition in patients without underlying immunosuppression. This report describes a patient who developed abdominal pain, constipation, and ascites. And later on, he was diagnosed with peritoneal TB following laparoscopy with peritoneal biopsy. The patient was an immigrant from a high TB burden country but had no other common risk factors for the development of peritoneal TB. Treatment with anti-TB therapy resulted in significant clinical improvement.