Metastatic Lung Cancer to the Distal Finger Presenting as Osteomyelitis.

Metastasis to distal phalanx is a rare site for metastasis. It is often misdiagnosed as osteomyelitis because of similar clinical features, symptoms, and radiologic findings. If preceded by trauma, the diagnosis could be difficult. We are presenting a case of a 69-year-old male cigarette smoker, who presented with progressive painful swelling of the right second digit for two months duration after he lacerated his finger by a fingernail clipper. After receiving several unsuccessful courses of antibiotics, he was admitted for further treatment. Based on the CT scan of the right hand, he was treated for osteomyelitis and scheduled for elective surgery. As a part of the preoperative workup, his chest X-ray (CXR) revealed a left lower lobe infiltrate, and a subsequent CT of the chest demonstrated a 6 cm mass in the left lower lobe. The pathologic findings of lung mass and finger biopsy revealed a poorly differentiated carcinoma. The patient was treated with several cycles of chemotherapy before he decided to seek hospice care.  Certain malignancies have increased receptors for wound-healing factors. For those malignancies, trauma will promote local metastasis by releasing wound-healing factors that create a favorable environment for micrometastasis cell growth. Some of these components currently are targets for therapy, while other components may be targets for therapy in the future.

Eosinophilic Gastroenteritis Presenting As Unexplained Chronic Abdominal Pain.

A 27-year-old Caucasian female was hospitalized three times over a four-month period for recurrent, intermittent abdominal pain associated with nausea and diarrhea. No signs or symptoms of gastrointestinal (GI) bleeding were present. A stool occult blood test and stool enteric pathogen tests were negative. A complete blood count (CBC) revealed a peripheral blood eosinophil count of 1080 cells /µL without any inflammatory reaction. An upper endoscopy showed grossly normal-appearing esophageal and duodenal mucosa; however, a gastric mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/high power field (HPF). Based on these findings, she was diagnosed with eosinophilic gastroenteritis (EGE). A definitive diagnosis of EGE should be confirmed with both an analysis of gastrointestinal mucosal biopsy and an elevated peripheral blood eosinophil count. Specifically, histological evaluation of the mucosal tissue must show an eosinophilic infiltration rate of 20 eosinophils/HPF. The diagnosis should be followed by an extensive review of the patient's allergic disease history.