Endocarditis by Streptococcus pasteurianus.

The diagnosis of infective endocarditis is challenging because it has a variable clinical presentation and nonspecific symptoms and can present in different forms, especially when an unusual etiological agent is involved. We present the case of a female in her 70s admitted to the hospital with a medical history of bicytopenia, severe aortic stenosis, and rheumatoid arthritis. She had several consultations during which she presented with asthenia and general malaise. A septic screen test was performed that would determine that Streptococcus pasteurianus was present in a blood culture (BC), which was not valued. About three months later, she was hospitalized. In the first 24 hours of admission, the septic screen test was repeated and Streptococcus pasteurianus was isolated in BC. Splenic infarctions and transthoracic echocardiography suggested probable endocarditis, which was confirmed with transesophageal echocardiography. She underwent surgical intervention to remove the perivalvular abscess and replace the aortic prosthesis.

Malignant Hypercalcemia Induced by the Ectopic Production of Intact Parathyroid Hormone (PTH).

Malignant hypercalcemia is a common finding in patients with advanced cancer, involving mechanisms like tumor secretion of parathyroid hormone (PTH)-related protein, osteolytic metastases, and tumor production of calcitriol. Although rare, hypercalcemia induced by ectopic tumoral secretion of PTH can be an additional mechanism. Here we present an 84-year-old male patient who was admitted to the hospital with a non-productive cough, anorexia, and a single episode of small-volume hemoptysis. He was diagnosed with stage T4N3M1c left lung small cell carcinoma, and laboratory tests were remarkable for elevated ionized calcium as well as elevated serum intact PTH. A parathyroid 99mTc sestamibi scan showed no changes, suggesting ectopic production of PTH. Being a rare event, malignant hypercalcemia from intact PTH ectopic production should be considered in these patients.

Lung and Pleural Immunoglobulin G4-Related Disease: Two Contrasting Case Reports.

Immunoglobulin G4-related disease (IgG4-RD) is an immunomediated disease that can virtually affect any organ. Despite the pancreas being known as the most frequently involved organ, pulmonary and pleural IgG4-RD is being increasingly reported. The authors present two cases of IgG4-RD diagnosed in the same year, with different presentations and outcomes, in which the lung and pleural involvement were essential for the diagnosis. Recognizing IgG4-RD as a possible cause of chronic pleural effusion and/or thickening and lung abnormalities is important for an early diagnosis and prognosis improvement.

Mesalazine-Induced Interstitial Nephritis in a Patient With Ulcerative Colitis.

Acute interstitial nephritis (AIN) corresponds to a decline in kidney function due to an injury induced by drugs (in the majority of cases), infections, and autoimmune disorders. It is characterized by the presence of an interstitial inflammatory infiltrate in the kidney. Here, we describe a case of a man with a previous medical history relevant to ulcerative colitis (UC) who was admitted due to acute kidney injury (AKI) in the setting of AIN secondary to mesalazine.