A case of Lactobacillus jensenii associated native valve endocarditis.

Lactobacillus jensenii is rarely reported as a cause of endocarditis in immunocompetent patients. We describe a case of Lactobacillus jensenii associated native valve endocarditis that was identified using matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) technology. While most Lactobacillus species are generally resistant to vancomycin, Lactobacillus jensenii is frequently susceptible, but treatment requires accurate susceptibility results followed by timely medical and surgical intervention. Probiotic use in patients can be a risk factor for infection with Lactobacillus species.

A 58-Year-Old Man with a Painful Gluteal Mass as the First Presentation of Metastatic Adenocarcinoma of the Lung.

BACKGROUND Lung cancer is the second most common cancer, with the highest mortality rate. It frequently metastasizes to the nervous system, bone, adrenal gland, and liver. Rarely, it metastasizes to soft tissues, including cutaneous, subcutaneous, and skeletal muscles, with an overall prevalence rate of 2.3%. In most cases, soft-tissue metastases develop after an initial diagnosis of the primary internal malignancy and late in the disease course. In exceedingly rare cases, they may coincide with or occur before primary cancer has been detected. In our case, the initial manifestation of primary lung adenocarcinoma was a gluteal mass. CASE REPORT We present the case of a 58-year-old man with no other medical comorbidities other than a 40-pack-year smoking history, who initially presented with a solitary painful right-buttock mass. Imaging revealed a solid right gluteal soft-tissue mass along with lumbar, lung, hepatic, bilateral renal, and adrenal lesions concerning for an underlying metastatic pathology. A gluteal mass biopsy showed poorly differentiated adenocarcinoma with immunohistochemistry (TTF-1+CK7+CD20-) favoring primary lung cancer. CONCLUSIONS Although it is an unusual and uncommon presenting entity of lung cancer, our case report accentuates how a simple solitary cutaneous palpable mass can be an alarming sign of a serious underlying occult malignancy. Moreover, our case report also highlights the diagnostic and prognostic value of immunohistochemistry characteristics of the tumor and how it can guide the clinician to identify the primary site, which, in this case, was adenocarcinoma of the lung.

Hemorrhagic Pericardial Effusion Leading to Cardiac Tamponade: A Rare Initial Presentation of Adenocarcinoma of the Lung.

Malignancy associated pericardial effusion is a serious condition and testifies to poor prognosis. Cardiac tamponade can be the first presentation of underlying adenocarcinoma of the lung. We present a 78-year-old female with no known history of any malignancy, who presented with symptoms of abdominal and respiratory pathology. The physical exam findings were significant for a possible cardiac tamponade. Computed tomography (CT) of the abdomen and chest confirmed moderate bilateral pleural effusions, large pericardial effusion, left upper lobe mass, possible lymphangitic spread of carcinoma in the left lung, and adenopathy in the mediastinum. The echocardiography findings further confirmed tamponade. Cardiology and pulmonary medicine were taken on board for a possible malignancy associated pleural effusion leading to cardiac tamponade. Pericardial fluid analysis showed atypical cells suggestive of malignancy. Transbronchial biopsy confirmed moderately differentiated invasive adenocarcinoma. Positron emission tomography (PET) scan revealed metastatic spread to the mediastinum and right hilum with possible pleural metastatic disease seen posteriorly in the left hemithorax. The patient was discharged home with oncology follow up for chemotherapy.

A Case of Post-COVID-19 Subacute Thyroiditis.

Subacute thyroiditis is usually a self-limiting inflammatory condition. The clinical presentation varies from person to person, but usually includes neck pain or discomfort and a painful diffuse goiter. There is at times a transient episode of hyperthyroidism followed by euthyroidism and sometimes hypothyroidism. We describe the case of a previously healthy 29-year-old female presenting with symptoms consistent with subacute thyroiditis. The patient had recently recovered from a mild episode of COVID-19 infection. Labs and imaging were consistent with the clinical diagnosis of subacute thyroiditis. The patient was provided symptomatic treatment with prednisone and atenolol and had an uneventful recovery.