The Uncharted Link Between Desogestrel and Hypercalcemia.

This report presents a unique case of hypercalcemia with an elusive etiology. A 37-year-old Caucasian female with a history of gonadotropin-secreting pituitary microadenoma and recurrent nephrolithiasis was found to have hypercalcemia, hypercalciuria, elevated 1,25-dihydroxyvitamin D levels, and low parathyroid hormone levels. Extensive investigations were conducted to identify the cause, including ruling out sarcoidosis and other granulomatous disorders. Imaging and diagnostic testing revealed normal results. The patient's condition considerably improved after the cessation of an oral contraceptive pill containing desogestrel. This surprising association raises the possibility that the use of desogestrel could result in hypercalcemia as one of the side effects. To ensure proper care and avoid consequences linked to severe hypercalcemia, a high index of suspicion is needed to detect the underlying cause of hypercalcemia, even in the absence of usual indications.

Porphyromonas asaccharolytica as a Rare Causative Agent for Lemierre's Syndrome.

Lemierre's syndrome is a rare disease associated with significant morbidity and mortality. It begins with an oropharyngeal infection, which spreads locally to involve the internal jugular vein causing thrombophlebitis, followed by distant spread and metastatic infections. Affected individuals are commonly young adults. Causative organisms are usually oropharyngeal flora, most commonly being the anaerobe Fusobacterium necrophorum. Porphyromonas asaccharolytica is a rare etiological agent with only three cases being reported in the literature. This case report describes a previously healthy 22-year-old man who initially presented with acute tonsillitis and was later found to have left internal jugular vein thrombophlebitis along with bilateral septic emboli to the lungs. The patient was treated with a five-week course of ampicillin-sulbactam and metronidazole. Subsequent imaging also showed progression of internal jugular vein thrombus, for which warfarin was given for three months for anticoagulation.

STEMI in a Young Male after Use of Synephrine-Containing Dietary Supplement.

A twenty-two-year-old male with no significant past medical history who presented with chest pain was found to have ST-segment elevation in leads II, III, aVF, and V4-V6. On subsequent EKGs, patient had new ST-segment elevations in anterolateral leads with dynamic changes. Cardiac catheterization showed acute dissection with thrombosis of the distal left main coronary artery leading into the ostial left anterior descending artery. The patient had no cardiac risk factors including hypertension, hyperlipidemia, diabetes, or family history of early cardiac disease. On further inquiry, the patient was found to be on two separate performance-enhancing supplements which contained synephrine, a sympathomimetic chemical which was later attributed as the cause of his acute coronary syndrome. Synephrine acts on alpha-1 adrenergic receptors causing peripheral and coronary vasoconstriction, hypertension, and hyperglycemia. Increased hemodynamic stress on the coronary arteries can lead to fatal dissections. Ours is an atypical case of synephrine-induced nonatherosclerotic spontaneous coronary artery dissection which helps caution the physicians about the importance of dietary supplement use in the history and possible side effects of such performance-enhancing additives.