Intractable Nausea in a Heart Transplant Patient.

We present a case of a 59-year-old woman who had been recently diagnosed with a cavitary lung nodule and then started on voriconazole; she had been diagnosed with breast cancer about 10 years prior, which had been treated with anthracyclines and subsequent non-ischemic cardiomyopathy, ultimately requiring an orthotopic heart transplant. She presented to the hospital due to nausea and abdominal pain. She was found to have cholelithiasis, without cholecystitis, and was initially discharged with plans for an outpatient cholecystectomy. However, nausea and pain persisted, and hence she was readmitted and had a cholecystectomy but her nausea continued. Further workup revealed an elevated voriconazole level, and her nausea resolved once the voriconazole was discontinued.

An Unexpected Occurrence of Malignancy in a Patient After a Fontan Operation.

An 18-year-old male with complex single ventricle physiology status post Fontan and Kawashima procedures who presented with progressive dyspnea was found to have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rhinovirus, and a new retroperitoneal mass. Biopsy of the retroperitoneal mass revealed a mixed germ cell tumor with areas consistent with choriocarcinoma. Imaging showed metastatic disease, including to the lungs which ultimately led to worsening respiratory failure that required intubation and ultimately, death.

Amlodipine-Induced Liver Injury.

This is a case of an 88-year-old female with a history of hypertension who was started on amlodipine about three weeks prior to presentation. After about two weeks of amlodipine therapy, she developed intermittent right upper quadrant pain as well as pruritus which continued for a few days before she presented to medical attention. Her labs showed significantly elevated liver enzymes so she presented to the hospital for further evaluation. Imaging was unremarkable, her infectious and autoimmune workups were all negative. The amlodipine was discontinued and her liver enzymes slowly normalized after about seven weeks.

Ascending Aortic Thrombus After SARS-CoV-2 Infection.

A 46-year-old male with a history of SARS-CoV-2 infection one month ago presented to the hospital due to acute onset left flank pain. He was found to have an acute left renal embolic infarction from a large 15mm ascending aortic thrombus, which may have formed due to a transient hypercoagulable state from his recent SARS-CoV-2 infection along with tobacco use. He was medically managed with anticoagulation for six months. Subsequent imaging after three months of therapeutic anticoagulation showed complete resolution of the ascending aortic thrombus.

Non-O1, non-O139 Vibrio cholerae bacteremia in an urban academic medical center in the United States.

Non-O1, non-O139 Vibrio cholerae (NOVC) are genetically diverse strains that are generally non-pathogenic in healthy hosts. In immunocompromised patients or those with liver disease, NOVC have been shown to cause gastroenteritis, wound infections or sepsis and are often associated with high mortality rates. We report a case of a patient with liver cirrhosis and chronic venous insufficiency who was found to have NOVC bacteremia. The patient had recently visited Florida, USA but had no seafood consumption or exposure to aquatic environments. The patient was managed with antimicrobials, with a favorable outcome.