A Unique Presentation of Bacterial Group G Streptococcus Myopericarditis.

Perimyocarditis and myopericarditis are inflammatory conditions of the pericardium and myocardium, often of idiopathic or infectious etiology, with viral infections being the most common. Nonrheumatic streptococcal myopericarditis (NSM) is a rare condition that can mimic acute myocardial infarction. This case report presents a 22-year-old male with no prior medical history who developed NSM following a streptococcal pharyngitis infection. The patient presented with pleuritic chest pain, tightness, and decreased exercise tolerance. Laboratory studies revealed elevated troponin levels and positive Streptococcus G antigen. Treatment included ampicillin-sulbactam, colchicine, ibuprofen, and dexamethasone. The patient's symptoms resolved, and he was discharged with amoxicillin-clavulanate, colchicine, and ibuprofen.

Incidental finding or the incognito culprit? A case of Mounier-Kuhn syndrome.

Mounier-Kuhn syndrome, characterized by tracheal dilatation due to the loss of elastic fibers and smooth muscle cells, is a rare condition, often leading to recurrent respiratory infections from impaired mucociliary clearance.

A rare occurrence of isolated superior mesenteric artery dissection, a case image report.

Isolated spontaneous superior mesenteric artery (SMA) dissection is relatively rare. Often found incidentally on cross-sectional imaging, often managed non-operatively. We present a patient who presented with chest pain and was found to have a SMA dissection.

Carbohydrate Antigen (CA 19-9) Surge: Unraveling the Enigma of Elevated Levels in the Setting of Benign Etiologies.

Carbohydrate antigen 19-9 (CA 19-9) is widely recognized as a tumor marker primarily associated with pancreatic cancer. However, its elevation in benign pancreaticobiliary conditions complicates its diagnostic utility. We present the case of a 39-year-old male with no significant medical history who presented with symptoms of abdominal pain, nausea, vomiting, and diarrhea. The initial diagnosis suggested viral enteritis, but the subsequent worsening of symptoms led to further investigation. Elevated white blood cell counts, bilirubin levels, and liver function tests prompted magnetic resonance cholangiopancreatography (MRCP), which revealed dilated bile ducts and acute cholecystitis. Following endoscopic retrograde cholangiopancreatography (ERCP), significant hemobilia was observed, raising suspicions of cholangiocarcinoma. Despite extensive investigations, including CT angiography, MRCP, and repeat ERCPs, no malignancy was detected. Remarkably, the CA 19-9 level was elevated to 904 U/mL after the initial ERCP and uptrended to 7380 U/mL. These levels, however, normalized to 13 U/mL within two weeks of discharge. While CA 19-9 is a valuable marker in the diagnosis of pancreatic cancer, its elevation in benign pancreaticobiliary conditions necessitates cautious interpretation. In our case, choledocolithasis, cholangitis, and biliary manipulation appeared to have contributed to a transiently elevated CA 19-9. Clinicians must consider the entire clinical context when evaluating elevated CA 19-9 levels to avoid misdiagnosis and ensure appropriate patient management.

Splenic Surprise: Investigating a Case of Splenic Infarct as an Isolated COVID-19 Manifestation.

Coronavirus disease 2019 (COVID-19) infection has been associated with a multitude of complications, one established complication being thromboembolism, a result of the proinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This prothrombotic state is a cumulation of many inflammatory pathways at work. Here, we present an interesting case of a 43-year-old female who did not present with the typical COVID-19 clinical picture. Instead, she presented with periumbilical pain, nausea, and vomiting. Upon further investigation, she was found to have a splenic infarct on a computed tomography (CT) scan. An extensive workup was performed to explore possible etiologies; however, it was concluded that her splenic infarct was secondary to her COVID-19 infection. With this case, we aim to add to the literature regarding the manifestations of the prothrombotic state of SARS-CoV-2.

A symphony of anomalies: Isolated pulmonary artery agenesis meets congenital lung hypoplasia.

Isolated agenesis of pulmonary arteries with congenital lung hypoplasia is rare. It can be found in childhood or adulthood if asymptomatic. We present a patient with congenital right lung hypoplasia with an absent right pulmonary artery.

The Great Imitator: A Case of Lyme Carditis Mimicking ST Elevation Myocardial Infarction.

Lyme disease, caused by Borrelia burgdorferi and transmitted via Ixodes ticks, is a common vector-borne illness in the United States, with an estimated 476,000 annual cases. While primarily known for its neurological and rheumatological manifestations, Lyme disease can also involve the cardiac system, known as Lyme carditis, which occurs in about 4% to 10% of cases. This case report details a rare instance of Lyme carditis presenting as ST-segment elevation myocardial infarction (STEMI) in a 31-year-old female with no significant medical history. The patient exhibited symptoms of chest pressure and shortness of breath, with laboratory results showing significantly elevated troponin levels and other indicative markers. Notably, cardiac catheterization revealed no coronary occlusion, suggesting an alternative diagnosis to acute coronary syndrome (ACS). Further testing confirmed Lyme carditis through positive serological tests for Lyme-specific IgM antibodies. The case underscores the importance of considering Lyme myopericarditis in differential diagnoses for STEMI in Lyme-endemic areas and in patients without typical risk factors for coronary artery disease. This report aims to increase clinical awareness of this condition, highlighting the need for thorough investigation in atypical cardiac presentations.

Rare Case of Mycobacterium Avium Complex Peritonitis in a Patient with Multiple Myeloma Undergoing Peritoneal Dialysis.

Mycobacterium avium complex (MAC) infections can present as a variety of severe diseases. While it has a predilection for immunocompromised patients such as those with Human immunodeficiency virus (HIV), it can also affect immunocompetent patients as well. One of the rare yet severe diseases that MAC infections can present is MAC peritonitis. Often hard to distinguish from other causes of peritonitis, high clinical suspicion should be maintained for those who are susceptible. Here we present an 85-year-old female with a past medical history of end-stage renal disease on peritoneal dialysis who presented with nausea and vomiting. She was found to have tenderness around her peritoneal dialysis site and was noted to have mild ascites. Her labs were significant for several electrolyte abnormalities, leukocytosis, and ascitic fluid obtained during a previous admission, and serology was positive for acid-fast bacilli. It was further revealed that the species was Mycobacterium avium complex. Initially, she started on rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE), subsequently antibiotics were changed to azithromycin, ethambutol, and rifampin after MAC identification in acid-fast bacilli culture. We aim to highlight this rare presentation of peritonitis secondary to MAC.

Cranial Conundrum: An Unusual Case of an Epidermoid Cyst in the Prepontine Cistern.

We present a fascinating case of a patient who suffered from persistent headaches for three months due to an epidermoid cyst located in the prepontine cistern. Epidermoid cysts are a very uncommon type of intracranial tumor, known for their slow growth and gradual onset of neurological symptoms. In this particular case, our patient, a 35-year-old, experienced a headache that was accompanied by dizziness, photophobia, and pain when moving their eyes. Further imaging revealed a cystic lesion in the prepontine cistern, which had a mass effect on the pons. After confirming the lesion was likely an epidermoid cyst through an MRI, the patient underwent surgery to have it removed. We hope to highlight the rarity of this type of tumor and its unique features when viewed through imaging.

A Case Report and Literature Review of Gastric Stump Carcinoma: An Uncommon Entity Following the Billroth II Procedure.

Gastric stump carcinoma is a rare phenomenon and could occur in individuals after a distal gastric resection. Regardless of the surgical approach, it can lead to certain complications. However, the Billroth II gastrojejunostomy procedure has been noted to have some specifically interesting complications due to the anatomical changes it triggers. These changes, such as bacterial overgrowth and enterogastric reflux, can cause metaplasia. We discuss a case of an 81-year-old male with a history of peptic ulcer disease (PUD) status post-Billroth II gastrojejunostomy 30 years prior who presented with a four-day history of bright red blood per rectum. On esophagogastroduodenoscopy (EGD), he was found to have friable, ulcerated mucosa at the anastomosis site. Biopsy results revealed CDX2-positive cells, indicating gastric adenocarcinoma. Although it is well-known that the anatomical changes of gastrojejunostomy will undoubtedly change the microbiome of the stomach, physicians should also be mindful of the more feared complications such as gastric stump carcinoma.