A Unique Case Of Tenofovir-Induced DRESS Syndrome Associated With Raynaud's Of The Tongue.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a potentially fatal severe adverse reaction to medications. Numerous drugs have been implicated, with carbamazepine and allopurinol being the most common. Tenofovir-induced DRESS is extremely rare. We report a case of a 65-year-old male patient with a diffuse exfoliative maculopapular rash across his entire body of five weeks of duration. The patient also had icteric sclera, abnormal liver enzymes and Raynaud's of the tongue, nose and the left fifth finger. After discontinuation of tenofovir, the case resolved over a span of ten days. A high index of suspicion is crucial along with the prompt withdrawal of the offending medication for a good outcome.

Virchow's node: a case report of an extremely rare presentation of metastasis of adenocarcinoma with mucinous features from the colon.

Colon cancer is one of the most common causes of cancer-related mortality. Adenocarcinoma with mucinous features accounts for 10-15% of colon carcinoma. Distal nodal metastatic colorectal cancer is uncommon, and metastasis of colorectal cancer to the left supraclavicular lymph node is extremely rare without signs of metastatic organ involvement. We present a case of a 54-year-old Caucasian male with colonic adenocarcinoma that presented initially as a left-sided neck mass that had progressively increased in size over 9 months. On physical exam, a left supraclavicular soft tissue mass 6 cm in diameter was appreciated, it was non-tender with no submandibular lymphadenopathy. Soft tissue mass was palpable on the anterior abdominal wall in the epigastric region. Open excisional tissue biopsy of the left supraclavicular mass revealed metastatic adenocarcinoma with mucinous features and colonoscopy revealed a 6 cm obstructing mass in the transverse colon with biopsy revealing primary adenocarcinoma of the mucinous type. Palliative care with comfort measures was agreed upon. Typically, the most common sites of colon cancer metastasis are regional lymph nodes, liver, lung, bone and brain, and ours demonstrated an extremely rare pattern of colon cancer metastasis. The presentation to metastasize to the left supraclavicular node without solid end organ involvement makes this case even more novel.