Sculpting the Silent Intricacies: A Rare Triad of Syphilitic Aneurysms Unveiled.

This case report revolves around a 73-year-old male patient who initially sought medical attention due to left lower extremity weakness. Suspicions of a potential vascular etiology arose during the initial clinical examination, prompting further investigation. Unexpectedly, computed tomography (CT) imaging of the abdomen and pelvis revealed the presence of three giant aneurysms. Concurrently, positive syphilis titers were identified. The patient's presentation, marked by focal neurological deficits, unveiled the incidental discovery of a triad of aneurysms involving the distal abdominal aorta, right common iliac, and left common iliac. The neurological symptoms observed in the patient were attributed to the compression within the left common iliac artery, leading to compromised blood flow to the lower extremity. Alternatively, the neurological deficits could be linked to neurosyphilis or a combination of both factors. This case underscores the critical role of considering syphilis in patients presenting with neurological symptoms. The unique discovery of extensive aortic abnormalities through imaging studies, specifically CT angiography, emphasized the importance of such diagnostic tools in unraveling complex and potentially life-threatening vascular pathologies. Recognizing the diverse manifestations of syphilis in patients with vast neurological symptoms is crucial for timely diagnosis and multidisciplinary management. This case emphasizes the need to keep a high index of suspicion for syphilis in individuals who have widespread aortic anomalies together with neurological symptoms, to sum up. The triad of aneurysms discovered incidentally in this 73-year-old patient underscores the intricate interplay between vascular and neurological manifestations. The timely diagnosis and multidisciplinary management of both the neurological and vascular aspects of this unique presentation are essential for ensuring optimal patient outcomes.

A Rare Case of Acute Myeloid Leukemia Initially Presenting With Fever of Unknown Origin and Rapidly Progressing Pericardial Effusion.

This case report highlights a patient who had persistent fevers for weeks and rapidly progressing pericardial effusion following a positive test for coronavirus disease 2019 (COVID-19) two weeks before presentation to the hospital. The initial thought was that her fever was of infectious etiology, but relevant investigations led to the diagnosis of acute myeloid leukemia (AML). AML, which is characterized by clonal expansion of immature "blast cells" in the peripheral blood and bone marrow resulting in ineffective erythropoiesis and bone marrow failure, is the most prevalent form of leukemia. It is the most aggressive form of leukemia, which has varying prognoses determined by the subtypes. This report explores the association between AML, fever of unknown origin, and pericardial effusion, shedding light on a notable clinical aspect. Fever in AML may be attributed to underlying inflammatory processes, cytokine dysregulation, or bone marrow failure. Recognition of fever as a potential indicator of AML contributes to enhanced clinical vigilance. Pericardial effusions and cardiac tamponade, although rare, can be a presenting feature of AML, and can present side by side with fever of unknown origin as seen in this case report.

Infective Endocarditis Due to Serratia odorifera: A Case Report and Literature Review.

Serratia odorifera from the time of its discovery in the 1970's had been considered a common colonizer of the skin with little pathogenic potential. Cases of human infections caused by S. odorifera are relatively rare. To date, very few cases have been reported describing primarily bloodstream and urinary tract infections. We describe a patient who developed endocarditis due to S. odorifera confirmed with a transesophageal echocardiogram. The patient was treated with six weeks of antibiotics with uneventful recovery. After a thorough review of published literature, we concluded that this is the first case of endocarditis caused by S. odorifera reported in English literature.

Salmonella Group B Ileitis Mimicking Crohn's Disease: A Case Report.

Salmonellae, considered among the enteric-fever-causing pathogens, is associated with a range of human infections, including gastroenteritis, bacteremia, and osteomyelitis. Salmonella-induced mesenteric adenitis and terminal ileitis resembling acute appendicitis have been reported in the literature. Here, we present a rare case of a patient presenting with severe acute active ileitis and colitis mimicking Crohn's disease with no prior history of inflammatory bowel disease and found to have Salmonella group B bacteremia.

The Association of Mycobacterium tuberculosis with Kikuchi Syndrome: A Case Report and Literature Review.

Kikuchi-Fujimoto disease (KFD) is considered one of the rare benign conditions of unknown etiology presenting with the triad of cervical lymphadenopathy, fever, and weight loss. The inciting cause continues to be elusive. One of the leading thoughts is that it may be a post-infectious immune response of T-cells and histocytes. The most common triggers reported have been viral infections. Treatment mainly revolves around the reduction of the inflammatory response with anti-inflammatory medication and steroids when appropriate. To date, there are very limited reports of Mycobacterium tuberculosis as an inciting agent documented. Here, we present a rare case of Kikuchi-Fujimoto disease following Mycobacterium tuberculosis infection, more than four years after the completion of therapy.

Posterior Reversible Encephalopathy Syndrome in an Adult Male With Uncontrolled Blood Pressure and Cocaine Use: A Case Report.

Posterior reversible encephalopathy syndrome (PRES) is a subacute syndrome that is diagnosed by neurologic symptoms and radiologic findings. PRES is predominantly caused by uncontrolled hypertension though it has been associated with illicit drug use, specifically cocaine use. We describe a case of a 68-year-old male who developed visual disturbances and gait abnormalities. Imaging was confirmed with head CT that showed hypoattenuation in the posterior aspects of the occipital lobes. The patient was managed with anti-hypertensive medication and blood pressure monitoring during his hospital course. Therefore, the patient's neurological symptoms resolved once the blood pressure was well-controlled. MRI of the brain was completed prior to discharge and confirmed resolution. Hypertension and cocaine use has been documented as causative agents of PRES. It is most likely due to the inability of the posterior circulation of the brain to auto-regulate with acute changes in blood pressure resulting in hypoperfusion and disruption of the blood-brain barrier with resultant vasogenic edema without infarction.

A Rare Case of Polymerase Chain Reaction-Negative Severe Clostridioides difficile Infection.

Accurately diagnosing Clostridioides difficile infection (CDI) is crucial for effective patient management. A misdiagnosis poses risks to patients, leads to treatment delays, and contributes to infection transmission in healthcare settings. While using polymerase chain reaction (PCR) to amplify the toxin B gene is a sensitive method for detecting toxigenic C. difficile, there is still a risk of false-negative results. These inaccuracies could have significant consequences for diagnosing and treating CDI, emphasizing the need for careful consideration and other diagnostic approaches. This case report highlights a patient with severe CDI who had negative PCR and toxin and a biopsy showing pseudomembranous colitis on further testing due to persistence and worsening of symptoms. In the diagnosis of C. difficile infection, healthcare providers should consider clinical symptoms, although diarrhea, which is a major sign of CDI, can be due to other causes. Even in the presence of negative PCR results, if a patient displays symptoms consistent with C. difficile-associated disease, healthcare providers may still contemplate treatment.

What Works for One May Not Work for Another: A New Warning for Modafinil.

Narcolepsy is a clinical syndrome of hypothalamic disorder characterized by several sleep-wake disorders. The most common features include daytime sleepiness associated with hallucinations (hypnagogic and hypnopompic hallucinations) at the transition time of sleep-wake time, cataplexy or sudden loss of muscle tone, and sleep paralysis. We present a case of a patient affected with both narcolepsy and postural orthostatic tachycardia syndrome (POTS). POTS is a rare disorder characterized by orthostatic intolerance and abnormal autonomic response while sustaining an upright posture. In this case report, we highlight the impact of POTS on the choice of pharmacotherapy for narcolepsy.

Thoracic Gut Entrapment Presenting As Intractable Hypoxia: A Case Report of Chilaiditi Syndrome.

We present a rare case of a patient who had intractable hypoxia and was found to have Chilaiditi syndrome. The hypoxia and respiratory symptoms resolved after bowel decompression and relief of the mass effect of the entrapped gut in the thorax. Chilaiditi sign is the interposition of the colon between the liver and diaphragm. Colonic interposition is a common asymptomatic radiological finding, in Chilaiditi syndrome, patients experience symptoms such as abdominal pain, constipation, respiratory distress, and chest pain.

A Curious Presentation of May-Thurner Syndrome With Isolated Iliofemoral Deep Vein Thrombosis.

May-Thurner syndrome, which has been called by many names, including Cockett syndrome, iliocaval compression syndrome, and iliac vein compression syndrome, is an anatomic variation where there is extrinsic venous compression by the arterial system against the bony structure of the axial skeleton, most commonly right common iliac artery compressing the left iliac vein against the fifth lumbar vertebra. The persistent right common iliac pulsation results in endothelial irritation of the venous system and at the same time reduces venous return, hence satisfying two factors in Virchow's triad for the formation of venous thrombosis. Here we present a rare case of a patient who presented with multiple risk factors that could propagate the formation of deep vein thrombosis with the underlying anatomic variation of May-Thurner syndrome in the setting of dehydration, systemic infection, failure to thrive, and psychiatric decompensation. Treatment required fluid hydration, antibiotic therapy, and mechanical thrombectomy in conjunction with local infusion of thrombolytics. Subsequent stent placement was performed to prevent re-thrombosis and stenosis of the affected area with long-term oral anticoagulation.

Correction: What Works for One May Not Work for Another: A New Warning for Modafinil.

[This corrects the article DOI: 10.7759/cureus.27287.].

Pancolitis Associated With COVID-19 Infection: A Case Report.

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 infection commonly affects the pulmonary system, ranging from being asymptomatic to having mild upper respiratory tract infection symptoms, to having severe cases causing multi-organ failure. However, COVID-19 infection involving the gastrointestinal (GI) tract leading to pancolitis is an extremely rare complication. We present a rare case of a patient who presented with pancolitis and on testing for admission found to be positive for COVID-19. We will explore the GI tropism and the mechanism of COVID-19 infection with gastrointestinal symptoms of pancolitis.