Shoulder and Upper Back Pain: An Unusual Initial Presentation of Rare Stage IV Small Cell Neuroendocrine Cervical Cancer.

While musculoskeletal pain is cited as the primary cause of disability and reason for visiting the emergency department in the United States, secondary etiologies should be considered. In this case report, we are reporting a unique case of a 38-year-old multiparous healthy female who presented to multiple emergency departments with fleeting pain on the shoulders and upper back. She was diagnosed with muscle spasms and joint arthritis and discharged home multiple times. The patient then developed vaginal bleeding, belt-line numbness, and was found to have T6 spinal cord compression. Imaging prompted workup for malignancy, which revealed small cell neuroendocrine cervical cancer (SCNECC) with metastasis to intra-abdominal lymph nodes, bone, and brain. SCNECC is very rare, aggressive, occurs in less than 3% of cervical cancers, and does not have established treatment guidelines. Because it is commonly misdiagnosed and has an overall poor prognosis, SCNECC can be missed if it is not part of the differential.

Rare case of endogenous Klebsiella endophthalmitis associated with emphysematous prostatitis in a patient with diabetes, cirrhosis and COVID-19.

A 35-year-old Hispanic man presented with fever, chills, dysuria, diarrhoea, scleral icterus, tachycardia and tachypnea. He was found to be COVID-19 positive, CT of the pelvis revealed prostatic abscess, and urine culture grew Klebsiella pneumoniae Additionally, he was found to have diabetes and cirrhosis. During treatment, the patient developed vision loss, and was diagnosed with endogenous Klebsiella endophthalmitis. The patient was treated with intravenous antibiotics, pars plana vitrectomy, intravitreal antibiotics and cystoscopy/suprapubic catheter placement. On follow-up, the patient has had the suprapubic catheter removed, and successfully passed a voiding trial, but suffers permanent vision loss in both eyes.