Crohn's Disease Diagnosed in a Man with Sarcoidosis: Coincidence or Correspondence?

Crohn's disease and sarcoidosis are characterized by noncaseating granulomas, but rarely do they present in the same patient. Their coexistence presents a diagnostic challenge as they are often classified as clinically separate, despite their similarities. We present a case of a 59-year-old man previously diagnosed with pulmonary sarcoidosis who presented to the emergency room with abdominal pain and diarrhea. Colonoscopy revealed multiple ulcers in the colon, with histology in keeping with newly diagnosed Crohn's colitis. The patient had a good clinical response to initiation of steroid therapy and a tumor necrosis factor (TNF) inhibitor.

Chronic Diarrhea in a Drinker: A Breakthrough Case of Pellagra in the US South.

The triad of diarrhea, dementia, and dermatitis constitutes the clinical diagnosis of pellagra. However, most reported cases of pellagra have occurred without all components of the triad. Pellagra was declared eradicated in the United States after an outbreak in the 1920s, and is now considered to be an exceedingly rare diagnosis in developed countries. In this article, we present a case of a 56-year-old man who presented with a significant history of alcohol use and chronic diarrhea. Pellagra was clinically diagnosed based on the triad of diarrhea, cognitive dysfunction, and dermatitis in this malnourished, alcoholic patient. The patient was treated and clinically improved with resolution of his diarrhea and cognitive dysfunction.

Cocaine-Induced Ventilation/Perfusion Mismatch Mimicking Pulmonary Embolism.

Pulmonary complications from cocaine use can range from bronchospasm to vasospasm leading to pulmonary infarction. Profound vasospasm may also lead to perfusion defects presenting as pulmonary embolism on ventilation-perfusion scan. A 65-year-old patient with a past medical history of substance abuse and chronic kidney disease presents to the emergency department with sudden-onset chest pain and shortness of breath. Ventilation-perfusion scan revealed filling defect most notably in the lingual lobe. He was later discharged on warfarin for the management of pulmonary embolism. The patient presented to the emergency department 2 weeks later with similar complaints; the international normalized ratio was subtherapeutic, and urine drug screen was positive for cocaine. Repeat ventilation-perfusion scan revealed no filling defects. Follow-up bilateral venous Doppler of lower extremities and D-dimer were within normal limits.

Hepatic actinomycosis presenting as liver mass: case report and review of the literature

La actinomicosis primaria en el hígado es una entidad rara. Reportamos el caso de un joven con historial pasado de apendectomía, que presentó con fiebre, pérdida de peso y una masa hepática que incialmente se sospechó de índole neoplástica. Una biopsia hepática percutánea reveló la presencia de organismos parecidos a Actinomyces. El presente recibió tratamiento endovenoso y oral con Penicilina con buena respuesta clínica. Repasamos la literatura y consideramos la relación entre actinomicosis hepática y apendectomía previa