A Rare Case of Nodular Mantle Cell Lymphoma of the Gastrointestinal Tract Discovered During a Routine Colonoscopy With a Positive Response to R-CHOP Chemotherapy Regimen.

This report describes the case of a 73-year-old female patient who presented with abdominal symptoms. A colonoscopy identified a cecal mass confirmed as mantle cell lymphoma (MCL). Imaging showed extensive lymph node involvement. The patient received rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP) chemotherapy, resulting in tumor reduction and adenopathy resolution. Despite a typically unfavorable prognosis associated with a high Ki-67 index, the patient responded well to chemotherapy and achieved a favorable outcome. This case highlights the importance of early detection, appropriate treatment which in our case was R-CHOP, and personalized management approaches in addressing MCL.

Sarcoid-Like Reactive Lymphadenopathy in Metastatic Synovial Sarcoma.

A 56-year-old male underwent treatment for sarcoma with metastases to the lungs. Follow-up imaging revealed multiple pulmonary nodules and masses with a favorable response on positron emission tomography (PET) scanning showing enlarging mediastinal lymph nodes concerning for progression of the disease. To evaluate the lymphadenopathy, the patient underwent bronchoscopy with endobronchial ultrasound and transbronchial needle aspiration. The lymph nodes were negative for cytology but showed granulomatous inflammation. Granulomatous inflammation is a rare occurrence in patients with concurrent metastatic lesions and is exceedingly rare in cancers that have not originated in the thorax. This case report highlights the clinical significance of sarcoid-like reactions in the mediastinal lymph nodes and the need for further investigation.

Type 2 Decompensated Diabetes Mellitus Weaned off Subcutaneous Insulin Therapy by Utilizing a Continuous Glucose Monitoring Device.

A case series was conducted on three patients diagnosed with decompensated type 2 diabetes mellitus (T2DM) who had hemoglobin A1c (HbA1c) levels ranging from 9.5% to above 14%. Patients were self-monitoring blood glucose (SMBG) levels four times a day. These patients were seen at the resident continuity clinic and were placed on continuous glucose monitor (CGM) devices to monitor their blood glucose levels. To improve the effectiveness of the treatment closely, a CGM team consisting of transitional year and internal medicine residents was arranged. The CGM team provided comprehensive education and written instructions on dietary changes, insulin administration, and physical activity at monthly follow-up appointments. Before the instructions were given to the patients, they were reviewed and approved by the supervising attending physician who was a board-certified endocrinologist. Our CGM team successfully managed these three patients with T2DM by tailoring their insulin regimens by using real-time CGM data. With the help of close CGM monitoring, patients were successfully transitioned from requiring multiple subcutaneous insulin injections to oral anti-diabetics. After the transition, patients' T2DM remained well-controlled with an HbA1c level of less than 7% at their follow-up appointments. This case series demonstrated the successful implementation of CGM-guided T2DM treatment in a continuity clinic managed by residents. To our knowledge, the use of CGM-guided T2DM treatment in the setting of resident care has never been reported in the United States before. This may serve as a benchmark for other continuity clinics which residents run across the country.

Benign Intrapulmonary Schwannoma With High Uptake on Fluorodeoxyglucose-18 (FDG-18 PET) Presenting as a Pancoast Tumor.

A 46-year-old female patient was diagnosed with a rare and benign intrapulmonary schwannoma, a neurogenic tumor that represents approximately 20% of adult mediastinal tumors, with schwannomas being the most common subtype. The patient was initially asymptomatic; however, after a period of four years, the patient presented with bilateral extremity edema, chronic venous stasis, elevated right ventricular systolic pressure, and a slightly enlarged inferior vena cava. These symptoms were caused by the lung tumor compressing intrathoracic structures. This case highlights the need for early evaluation and proper management of neurogenic tumors to avoid serious symptoms and complications. It also emphasizes the importance of vigilant monitoring and prompt surgery to achieve the best outcome for patients with neurogenic tumors.

Empagliflozin-Associated Euglycemic Diabetic Ketoacidosis in a Patient With Type 2 Diabetes Mellitus.

Euglycemic diabetic ketoacidosis (euDKA) is an uncommon condition, which is characterized by an elevated anion gap metabolic acidosis with ketonemia/ketonuria, in the presence of normal blood glucose levels. Common risk factors for the development of this condition include pregnancy, prolonged fasting, acute pancreatitis, and bariatric surgery. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been identified as a rare cause of euDKA. A recent literature review on PubMed found only 86 case reports of euDKA secondary to SGLT inhibitors published in the medical literature up to December 2022. Here, we present the case of a 43-year-old man who was taking empagliflozin, an SGLT-2 inhibitor. The patient was found to have euDKA, which was likely an adverse effect of his medication.

Low-Dose Methotrexate Toxicity Presenting as Pancytopenia.

High-dose methotrexate (MTX, 5 g/week) is typically used for the treatment of different malignancies and may be associated with serious side effects, such as acute kidney injury, myelosuppression, and hepatotoxicity. On the other hand, low-dose MTX (10-25 mg/week) is considered to be a safe and effective treatment for autoimmune arthropathies. Toxicity due to low-dose MTX is rare but can present with serious complications, such as pancytopenia. In this report, we present the case of an 82-year-old woman who presented with low-dose, MTX-induced severe pancytopenia and was treated with leucovorin rescue therapy with granulocyte colony-stimulating factor (G-CSF) therapy.