Primary Left Thigh Melanoma Presenting as an Obstructive Hemorrhagic Melanoma of the Small Bowel.

Primary malignant melanoma of the small intestine is rare and infrequent. However, the small bowel is a relatively common metastatic destination for cutaneous melanoma. Given the fact that primary small intestinal melanoma is a controversial and rare diagnosis, we present a case in which the initial finding suggested a primary tumor. However, the patient was later diagnosed with a small left thigh melanoma after the diagnosis of primary malignant melanoma of the small bowel was established. As a result, we emphasize that all primary small intestinal melanoma must be thoroughly investigated for an alternative primary lesion. Additionally, we question if the diagnosis of primary malignant melanoma of the small bowel needs to be re-classified as small bowel melanoma of unknown primary, especially in cases in which the primary lesion is unidentified.

The Importance of Excisional Biopsy in Nodular Lymphocyte-Predominant Hodgkin's Lymphoma.

Hodgkin's lymphoma (HL) is a malignancy that is typically B-cell in origin. HL can be further classified into classical HL and nodular lymphocyte-predominant HL (NLPHL). NLPHL is a rare lymphoma. It commonly presents locally with palpable firm lymphadenopathy or mediastinal mass seen on chest imaging. Some patients may have B symptoms (fever, night sweats, and unintentional weight loss), splenomegaly, and hepatomegaly. We describe a case of NLPHL in a 32-year-old male with classical findings of this rare class of HL.

Thrombospondin Type 1 Domain-Containing 7A (THSD7A)-Associated Membranous Nephropathy Leading to Metastatic Neuroendocrine Carcinoma.

Idiopathic membranous nephropathy also known as primary membranous nephropathy (PMN) is a common cause of nephrotic syndrome often seen in nondiabetic adults worldwide, rising as high as 40% in adults over the age of 60. Most PMN is mediated by antibodies to the M-type phospholipase A2 receptor (anti-PLA2R) in nearly 70%-80% of individuals. Thrombospondin type 1 domain-containing 7A (THSD7A) accounts for 1%-5% of individuals with PMN. In these individuals, malignancies have a varying incidence of 6%-25%. We present a case of idiopathic membranous nephropathy with anti-PLA2R negative and THSD7A positive with an underlying metastatic neuroendocrine carcinoma. Our goal is to highlight the importance of cancer screening in individuals with THSD7A-positive PMN. In addition, although nonspecific, a negative anion gap may be an indicator of an underlying malignancy.

Hypertension-Induced Thrombotic Microangiopathy Leading to End-Stage Renal Disease.

Thrombotic microangiopathy (TMA) is a term used for a group of rare and life-threatening hematological conditions. Usually, these disease processes are characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and microthrombi leading to tissue or organ injury. We present a case of a 41-year-old male with TMA induced by uncontrolled hypertension leading to end-stage renal disease requiring hemodialysis. Our goal is to highlight the importance of distinguishing hypertension-induced thrombotic microangiopathy from other etiologies of TMA, particularly thrombotic thrombocytopenic purpura (TTP), and its effect on renal function despite treatment focused on blood pressure control. Thus, it is a challenging diagnosis for clinicians to determine whether to initiate plasmapheresis for prompt treatment of suspected TTP in the setting of severe hypertension with thrombocytopenia.

Severe Trichotillomania: An Unusual Trigger of Recurrent Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes that is most often seen in patients with type 1 diabetes mellitus. Current DKA management focuses on rapid treatment to prevent acute complications, educational intervention, and early discharge. However, patients with mental health conditions face additional barriers to establishing control over their diabetes and may be hospitalized often for DKA recurrence. Understanding a patient's mental health and intervening where necessary may be a crucial step in the effective treatment of DKA. We present a case of recurrent DKA in a young male who suffered from severe trichotillomania. Trichotillomania is a mental health disorder in which an individual has the compulsion to pull on hair because it feels good. By doing so, the skin barrier is compromised. This can lead to disfiguring lesions that can be very distressing for the individual; however, they report an inability to control the compulsion to stop pulling their hair. In our case, the patient disrupted the skin barrier, leading to increased susceptibility for recurrent infection and DKA.