An insidious case of infectious mononucleosis presenting with acute appendicitis diagnosed postoperatively: a case report.

Infectious mononucleosis (IM) is a syndrome caused by the Epstein-Barr virus. IM typically presents with fever, pharyngitis and lymphadenopathy. Rarely, it can cause acute appendicitis. We report the case of a 19-year-old female presenting with a chief complaint of colicky, non-radiating abdominal pain for 2 days. Abdominal examination revealed rebound tenderness in right iliac fossa tenderness and splenomegaly. The diagnosis of acute appendicitis was confirmed by computed tomography. She underwent laparoscopic appendectomy and mesenteric lymph node biopsy. She was later diagnosed with IM based on laboratory findings and histopathology results. She received a course of intravenous acyclovir and was discharged. This shows that IM may present with acute appendicitis as the initial presentation and may not be accompanied by any other significant symptoms of IM.

Multiple Primary Malignancies of the Colon, Stomach, and Kidney in a Patient with Bowel Obstruction Requiring Emergency Surgery: A Case Report.

BACKGROUND Multiple primary malignancy (MPM) is defined as 2 or more primary malignancies diagnosed in the same patient. Even though MPMs are rare, various associated tumors have been reported in the literature. We report the first case of triple synchronous primary malignancies: gastrointestinal stromal tumor, colon adenocarcinoma, and renal cell carcinoma. CASE REPORT A 63-year-old man presented to our emergency department with a 7-day history of diffuse abdominal pain and constipation. Examination revealed a distended abdomen and diffuse tenderness. Enhanced computed tomography showed a high-grade large bowel obstruction with the transitional zone seen at the splenic flexure, which was suspicious for primary colon cancer, and a hypodense lesion on the left mid-pole of the kidney. An emergency exploratory laparotomy revealed a splenic flexure mass, which was resected, and a left renal mass, which was excised. A stomach mass at the greater curvature was an incidental intraoperative finding; a wedge resection was performed for it. The pathology for each of the masses showed a primary malignancy. CONCLUSIONS Multiple primary cancers are rare and a multidisciplinary team approach is essential for management of these patients, be it preoperative, intraoperative, postoperative, or long-term surveillance.