A Case of Concurrence of Clonorchis Sinensis and Pancreatic Adenocarcinoma-A Diagnostic Dilemma.

Clonorchis Sinensis, a common liver fluke, is known to cause biliary disease and can present with a wide array of symptoms. It's mostly found in Asian countries due to consumption of undercooked or raw fish. Although Cholangiocarcinoma is a known serious complication of this disease, Pancreatic neoplasms are rare and have seldom been reported. Here, we report a case of an 80-year-old man who presents with pancreatic adenocarcinoma associated with Clonorchis Sinensis infection.

Syncope Following Treatment of UTI: A Case of Acute Hemolytic Anemia, Methemoglobinemia and Acute Renal Dysfunction Following Phenazopyridine Use in a Patient With G6PD Deficiency.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive genetic disorder which commonly affects males. It is due to a defect in the red blood cell enzyme, G6PD. Lack of G6PD makes the RBCs vulnerable to oxidant stress resulting in hemolysis. The severity of hemolytic anemia varies among individuals with G6PD deficiency. Here we present a case of an 80-year-old man admitted with syncope and jaundice. He was treated with phenazopyridine for a UTI 2 weeks ago. Subsequent investigation revealed G6PD deficiency as well as methemoglobinemia. Historically, phenazopyridine has been associated with causing methemoglobinemia and triggering hemolysis in G6PD deficient individuals. However, only a few cases have been reported in the last 60 years, making it a very rare occurrence.

Right Ventricular Thrombus Masquerading as a Tumor.

Cardiac tumors are an uncommon phenomenon. Although they can be cardiac in origin, most represent a distant neoplastic growth metastasizing to the heart. Cardiac tumors can be benign or malignant. They may be symptomatic or, more commonly, found incidentally. Clinical presentation is typically related to that of dispersed neoplasm. We report a case of a 36-year-old young man with an unusually large and smooth-surfaced right ventricular mass. The patient presented to the emergency department with exertional dyspnea for two weeks. Past medical history was significant for deep venous thrombosis with non-adherence to anti-coagulation. Computerized tomographic (CT) angiography showed bilateral pulmonary emboli and a hypodense opacity in the right ventricle. A transthoracic echocardiogram showed a right ventricular non-mobile mass. The patient underwent surgical removal of the mass, which pathology demonstrated to be a thrombus. Cardiac masses can be difficult to differentiate based on imaging alone. Physicians should maintain a high index of suspicion for intracardiac thrombi as early identification and prompt treatment are imperative in improving patient outcomes.

Tricuspid Valve Vegetation Secondary to Ovarian Cancer Leading to Acute Stroke via Pulmonary Arteriovenous Malformation.

We report a case of non-bacterial thrombotic endocarditis in a 52-year-old woman due to ovarian cancer that was complicated by acute ischemic stroke through pulmonary arteriovenous malformation. Echocardiography showed tricuspid valve vegetation and a positive bubble study that revealed pulmonary arteriovenous malformation in the absence of patent foramen ovale. The patient opted for palliative management and was discharged home with comfort care.