Acquired Thrombotic Thrombocytopenic Thrombocytopenia Presenting As Urinary Tract Infection and Perianal Abscess: A Case Review.

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life-threatening hematologic disorder characterized by hemolytic anemia, thrombocytopenia, renal failure, fever, and neurologic dysfunction. While cases often do not present with all five characteristics (<5%), TTP can be hereditary or acquired, often due to a deficiency or dysfunction of the ADAMST13 enzyme. Here, we describe a case of infection-induced acquired TTP in a middle-aged male with urinary tract infection (UTI) and perianal abscess. Suspicion arose from hematologic abnormalities, fever, thrombocytopenia, acute renal failure, and the presence of an underlying infection. A PLASMIC score of 6 (indicating a 72% probability of ADAMTS13 deficiency) prompted ADAMTS13 level testing, revealing levels <5% with the presence of an inhibitor, confirming TTP diagnosis. Treatment with high-dose steroids and daily plasma exchange yielded a swift platelet response, necessitating only two to three days of plasma exchange. In addition, incision and drainage of the perianal abscess were performed. The patient was discharged on daily prednisone and initiated on four doses of weekly Rituximab to mitigate recurrence risk. This case underscores the importance of early suspicion and treatment in infectious triggers such as UTI/perianal abscess, offering crucial diagnostic and prognostic insights.

Early Mammogram Screening's Impact on Early Breast Cancer Detection in Underserved Populations.

Background Breast cancer remains a pressing public health challenge in the United States, ranking as one of the most prevalent cancers and the second leading cause of cancer-related deaths among women. This study investigates the effectiveness of early mammogram screening in underserved populations. Methods Data from female patients receiving primary care at a tertiary hospital in Nashville between January 2022 and January 2023 were retrospectively analyzed. Inclusion criteria encompassed females aged 40 or older with initial mammogram screenings before turning 50. Exclusions included genetically or environmentally related risk factors, cosmetic motivations, age above 50 at first screening, and screenings prompted by physical exams. Results Of 150 eligible women aged 40-49, the majority (n=121, 80.7%) had normal findings, 18.0% (n=27) had benign lesions, and 1.3% (n=2) had suspicious/malignant lesions. About 30.7% (n=46) underwent additional testing due to suspicious masses, with ultrasounds and diagnostic mammograms being common. The breast malignancy positivity rate was 1.33% (n=2) for the study population and 4.3% among those requiring additional testing. The positivity rate for the population of Black American descent is 1% (n=2), and for the Hispanic population, it is 6.25% (n=1). Discussion Breast cancer remains a significant concern, with disparities in screening guidelines and varying age of diagnosis. Overdiagnosis and false positives are challenges, with our study highlighting potential benefits in early screening, particularly for populations with unique risk factors, such as smokers. However, the study's limitations, including a small sample size and demographic bias, necessitate larger, more diverse studies to establish stronger correlations. Shared decision-making in early mammogram screening is emphasized. Conclusion Early mammogram screening in the 40-49 age group may detect breast cancer cases, but guidelines remain inconsistent. The study recommends early screening at age 40, with awareness of potential advantages and disadvantages. Larger, more comprehensive studies are needed to inform breast cancer screening practices better.

Paradoxical Left Ventricular Hypertrophy by Echocardiogram and Low Voltage ECG: A Key Clue in the Diagnostic Workup of Two Distinct Presentations of Cardiac AL Amyloidosis.

Cardiac amyloidosis remains a rare disease caused by the extracellular deposition of abnormal proteins-amyloids in the myocardium. These protein structures in the myocardium are associated with high morbidity and mortality, with prognosis hinging on early detection and treatment. Three main types of cardiac amyloidosis have been identified: light chain (AL), familial or senile (ATTR), and secondary amyloidosis which is associated with chronic inflammation. Cardiac amyloidosis classically presents as diastolic heart failure with symptoms of volume overload low voltage on electrocardiogram (ECG) and echocardiographic features of diastolic dysfunction and paradoxical left ventricular hypertrophy (paradoxical with respect to low voltage on ECG). Early suspicion should trigger additional laboratory and imaging workup to facilitate early detection. Early detection remains critical to prognosis. Herein, we present two patients admitted to a safety-net hospital within one month of each other with distinct presentations yet important, overlapping characteristics that led to the diagnosis of AL amyloidosis in both patients.