Rectal Stricture Caused by a Rare Plasmacytoid Urothelial Carcinoma.

Malignant rectal strictures are uncommon, but they may pose a diagnostic challenge in clinical practice. We report the case of an 85-year-old male with an initially puzzling presentation of abdominal distention and discomfort. The patient was ultimately diagnosed with a rectal stricture caused by a plasmacytoid variant of urothelial cell carcinoma originating from the bladder. This case emphasizes the necessity of considering unique etiologies when evaluating rectal strictures and the aggressive character of this type of urothelial carcinoma.

Complicated Treatment Course of Severe Asymptomatic Hypertriglyceridemia: A Case Report and Literature Review.

BACKGROUND Close observation, statins, fibrate treatment, and lifestyle changes can safely manage asymptomatic individuals with severe hypertriglyceridemia (HTG) and minimal risk of symptom development. However, the risk of medication-induced liver injury in patients taking statin-fibrate makes management more challenging, and may require hospital admission and close monitoring with follow-up. CASE REPORT We present a rare case of a 43-year-old man with asymptomatic severe HTG exceeding 11.370 mg/dL with mixed hyperlipidemia, managed initially with high-intensity statins and fibrate. However, due to the concurrent use of statin and fibrates, the patient subsequently developed an acute liver injury. Hence, the oral medications had to be stopped, and the patient was admitted to the hospital for an insulin drip. Even during the hospital course, the patient's triglyceride (TG) levels showed resistance to the recommended dose of insulin and he required a higher insulin dose. He was discharged on fenofibrate and subcutaneous insulin to keep the TG level under 500. Fibrate was stopped, and high-intensity statin was used as primary prevention with lifestyle modifications. CONCLUSIONS This instance highlights the necessity of increased cognizance and cooperative endeavors in handling severe asymptomatic HTG. Our results highlight the significance of further research into the management of severe asymptomatic HTG in cases of injury to the liver. This work adds essential knowledge to the ongoing discussion about managing a rare case complicated by acute liver injury.

Baker's Yeast Might not always be Good for Everyone - A Case of Percutaneous Gastrostomy Tube Induced Saccharomyces Cerevisiae Peritonitis in an Immunocompromised Patient.

Peritonitis, the inflammation of the protective membrane surrounding parts of the abdominal organs, is a common clinical pathology with multifactorial aetiologies. While bacterial infections are well-recognised as a cause of peritonitis, fungal infections remain relatively uncommon especially Saccharomyces cerevisiae, which is commonly used for breadmaking and as a nutritional supplement. This fungus has been reported to induce peritonitis in patients on peritoneal dialysis. However, it has never been reported as secondary to percutaneous endoscopic gastrostomy (PEG) tube insertion in immunocompromised patients. We present a 64-year-old female with a history of human immunodeficiency virus (HIV) who developed S. cerevisiae peritonitis following PEG tube insertion. The case highlights the importance of considering rare organisms when treating immunocompromised patients with peritonitis, especially after gastrointestinal tract penetration or peritoneal membrane disruption. LEARNING POINTS: Fungal infection can be a cause of peritonitis especially in an immunocompromised patient.Saccharomyces cerevisiae can be a pathological organism and induce serious infections.Early recognition of the cause of peritonitis and controlling the source is critical to prevent complications.

Stercoral Colitis-Induced Ischemia Mimicking acute Mesenteric Ischemia: A case report and Literature Review.

Stercoral colitis is a rare but serious condition characterized by inflammation of the colonic mucosa due to impacted and hardened faecal material. The word "stercoral" means "related to faeces". This condition usually develops due to the accumulation of hard stool masses in the colon, which cause localized inflammation and irritation. These faecalomas can exert persistent pressure on the colonic wall, causing damage and inflammation. Stercoral colitis presenting symptoms that mimic acute mesenteric ischemia is a diagnostic challenge for clinicians due to the overlap in clinical manifestations. Changes in bowel habits, bloating, and excruciating abdominal pain are potential manifestations of both illnesses, making it difficult to distinguish between them using clinical presentation. Diagnostic imaging, such as computed tomography scans, significantly discriminates between stercoral colitis and acute mesenteric ischemia. In cases where stercoral colitis mimics acute mesenteric ischemia, a thorough evaluation is essential to rule out vascular compromise. Timely and accurate diagnosis is crucial, as the management strategies for these two conditions differ significantly. Stercoral colitis often requires bowel evacuation and addressing the underlying faecal impaction. Acute mesenteric ischemia demands prompt vascular intervention to restore blood flow and prevent severe complications like bowel infarction. Given the potential overlap in symptoms and the critical importance of distinguishing between stercoral colitis and acute mesenteric ischemia, a multidisciplinary approach involving radiological imaging, clinical expertise, and timely intervention is essential for optimal patient care. This case highlights the importance of considering stercoral colitis when evaluating a patient with an acute abdomen, especially elderly patients with history of constipation. LEARNING POINTS: Constipation is a common condition that can lead to serious complications, especially in older people, and should be addressed as soon as possible.Early recognition of stercoral colitis and appropriate treatment can prevent critical consequences.Stercoral colitis can induce bowel ischemia, causing acute abdominal pain mimicking acute mesenteric ischemia.

Obstructive Jaundice Secondary to Hepatic Hilar Tuberculosis Without Pulmonary Involvement.

Tuberculosis (TB) is primarily a respiratory infection with huge mortality and morbidity worldwide. Extrapulmonary TB infection is common, affecting lymph nodes, pleura, and abdomen, but the prima-ry biliary presentation without lung involvement is exceedingly rare. We report on a 38-year-old male patient presented with isolated obstructive jaundice secondary to TB infection. This case highlights the importance of considering TB infection in the differential diagnosis of obstructive jaundice, especially in the endemic area. We also provide a literature review on TB infection, mainly in the biliary tract. LEARNING POINTS: Tuberculosis (TB) can affect the biliary system, mimicking cholangiocarcinoma without pulmonary involvement.Early recognition of biliary TB and treatment can prevent permanent complications and invasive intervention requirements.Using standard anti-tuberculous medications has shown high efficiency in treating and eradicating mycobacterial infection in such locations.

Symptomatic Gastric Diverticulum in the Antrum: A Case Report.

Gastric diverticulum is an out-pouching that occurs in the gastric wall and, often, when found, is incidental and asymptomatic. While they do not occur commonly, gastric diverticula are located most commonly in the posterior wall of the fundus of the stomach, and their presence in the antrum, as appreciated in the case described below, is quite rare. We present a 65-year-old female who was found to have an antral gastric diverticulum on esophagogastroduodenoscopy (EGD). There have been a few reported cases in the literature of gastric diverticulum that occurred in the antrum. This case report will shed light on this rare pathology, focusing on the occurrence in the antrum.

Long-Lasting SARS-CoV-2 Infection With Post-COVID-19 Chronic Interstitial Pneumonia in a Patient With Chronic Lymphocytic Leukemia Treated Successfully With Intravenous Immunoglobulin.

Post-coronavirus disease 2019 (post-COVID-19) condition is a post-acute syndrome characterized by non-specific symptoms that remain for at least two months and typically appear three months after the start of the acute phase. Individuals with chronic lymphocytic leukemia (CLL) are considered to be at high risk of contracting COVID-19. It is also becoming increasingly evident that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine response is frequently lacking or insufficient. We present a 77-year-old male patient with CLL who had multiple hospitalizations for the management of pneumonia related to persistent COVID-19 infection due to hypogammaglobulinemia. He was subsequently treated with intravenous immunoglobulin (IVIG). This case emphasizes the importance of the early detection of hypogammaglobulinemia in patients with CLL and long COVID because of the potential therapeutic benefit of IVIG therapy. We also provide a literature review on COVID-19 infection in CLL patients, focusing mainly on the subset population of patients with hypergammaglobulinemia.

Isolated tuberculosis liver abscess in an immunocompetent patient.

Isolated TLA is an extremely rare condition, but should always be considered in a patient presented with liver abscess, especially from an endemic area. Diagnosis depends on histological identification, with treatment being quadruple therapy.

Oral Iron Therapy-Induced Neutropenia in Patient with Iron Deficiency Anemia.

Iron deficiency anemia is common and worldwide distributed, particularly among females; however, it can also occur among males. Iron deficiency anemia is commonly associated with thrombocytosis; little is known about the effect of iron therapy (oral or intravenous) on other hematological parameters. We report a 29-year-old male patient with iron deficiency anemia, who received oral iron replacement therapy and developed neutropenia which recovered spontaneously 1 month later.