Pancreatic Dysfunction Masquerading as an Insulinoma.

Insulinoma is a rare neuroendocrine tumor that overproduces insulin, resulting in hypoglycemic symptoms. Elevated C-peptide levels in the absence of sulfonylurea use indicate insulinoma. Treatment is usually glucose administration and if the tumor size is large, surgery may be warranted. We present a case of a young man who had a one-year continuing episode of hypoglycemic symptoms that resolve after consuming high-glucose solids and liquids. Although symptoms pointed toward insulinoma, the 72-hour fasting test failed to show insulinoma. This case shows how following the algorithm accurately will prevent an inaccurate diagnosis.

Ischemic Colitis Secondary to Olanzapine and Clonidine Use in a Patient With a History of Laxative Abuse.

Ischemic colitis is the most common type of intestinal ischemia and is caused by an acute arterial occlusion, thrombosis, or hypoperfusion of the mesenteric vasculature. This case centers around a 39-year-old female with a past medical history significant for a 20-year history of stimulant laxative abuse, chronic constipation, bipolar disorder, and anxiety that presented with ischemic colitis following 21 days of obstipation. At the time of presentation, the patient was taking olanzapine 15 mg daily for the treatment of bipolar disorder and clonidine 0.2 mg three times daily for anxiety. Over the course of her hospitalization, the patient was found to have a high stool burden, including calcified stool, contributing to ischemic colitis. She was successfully treated with a clonidine taper, multiple enemas, and laxatives. Pharmacological agents that induce constipation have been shown to increase the risk of colonic ischemia by increasing intraluminal pressure in the colon. Atypical antipsychotics block peripheral anticholinergic and anti-serotonergic receptors, limit gastrointestinal muscle contractions, and delay intestinal transit.

Giant Parathyroid Adenoma: A Case Report.

Parathyroid adenomas rarely weigh more than 4 grams. Our patient had a 5.3-gram adenoma causing bilateral knee pain limiting mobility, constipation, low back pain, and frontal headache. Presenting with calcium of greater than 17 mg/dl, the patient was treated with two rounds of hemodialysis, calcitonin, Zoledronate, and aggressive IV hydration to decrease calcium levels before parathyroidectomy. The patient then went on to develop the hungry bone syndrome, which was treated with calcium carbonate and calcitriol. This rare giant parathyroid adenoma presents a unique opportunity to learn about the pathogenesis and treatment of longstanding hyperparathyroidism causing hypercalcemia-associated symptoms and hungry bone syndrome after parathyroidectomy.

Multiple Myeloma Uncovered Under Excessive Antacid and Chronic NSAID Use in a Young Female.

Multiple myeloma (MM) is a plasma cell dyscrasia in which nearly all cases are diagnosed in patients over 40 years old. This report illustrates a case of a young female who presented with severe generalized weakness, acute kidney injury, hypercalcemia, and anemia. Her symptoms were initially attributed to chronic NSAID and antacid intake, especially given her young age. However, further workup was pursued to rule out other potential diagnoses despite her age. She was ultimately diagnosed with multiple myeloma and started on bortezomib, cyclophosphamide, and dexamethasone. This report emphasizes the importance of maintaining a broad differential diagnosis. Untrained physicians can easily overlook rare cases. Timely diagnosis and treatment are key, and therefore, a high degree of suspicion is crucial for this patient population.

A Novel Case of Yamaguchi Syndrome in a Hispanic Male.

Yamaguchi syndrome or apical hypertrophic cardiomyopathy (HCM) is a unique variant of HCM. It is characterized by localized hypertrophy involving the left ventricular apex rather than the left ventricular septum. This syndrome has been traditionally seen in the Asian population, particularly those of Japanese descent. We present an interesting case of Yamaguchi syndrome seen in a Hispanic male. A 48-year-old Hispanic male presented with epigastric tenderness and was admitted to the hospital for a non-ST-segment elevation myocardial infarction. His diagnostic catheterization revealed no significant coronary artery disease. However, his echocardiogram revealed apical hypertrophy and narrowing of the left ventricular cavity at the apex, consistent with Yamaguchi syndrome. Case reports such as ours serve to help clinicians broaden their differential diagnoses when approaching patients with acute coronary syndrome-like symptoms to include diagnoses such as Yamaguchi syndrome.

Neuromyelitis Optica in a Healthy Female After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccine.

Neuromyelitis optica spectrum disorder is an autoimmune demyelinating disease with high relative prevalence in the East Asian population. Clinical manifestations include optic neuritis, longitudinally extensive transverse myelitis, area postrema syndrome, brainstem syndromes, and diencephalic syndromes. In this case report, we present a case of neuromyelitis optica spectrum disorder that developed 10 days after the first dose of the severe acute respiratory syndrome coronavirus 2 mRNA-1273 vaccine. The patient was a previously healthy White female, completely independent and functional at baseline. She presented with bilateral lower-extremity numbness/tingling, weakness, and urinary retention. Although her neuromyelitis optica IgG was negative, the MRI was consistent with neuromyelitis optica involving and spanning longitudinally the C6-T2 vertebrae. She was treated with IV steroids and her symptoms improved. Given the novelty of the COVID-19 vaccines and the paucity of literature regarding their adverse effects, case reports such as ours provide unique information that aids healthcare providers in accurately diagnosing and treating patients, ultimately minimizing long-term neurologic deficits.

A Retrospective Cohort Study on Predictors for Rehospitalizations With Recurrence of Atrial Fibrillation Post-Catheter Ablation for Atrial Fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is increasing in prevalence due to an aging population. Although medications for rhythm and rate control remain the first-line treatment options for many patients, difficulties can include arrhythmia relapse and drug side effects. Catheter ablation or radiofrequency is an alternative treatment modality that can isolate where ectopic arrhythmic sites originate. Several previous studies have examined post-ablation complications and hospitalization rates for arrhythmia recurrence. However, many of these studies used patient data from before 2015. We examined the following data using recent records: pre-procedural patient characteristics, rates of post-procedural hospitalizations with documented recurrence of AF, and patient risk factors associated with these recurrences.

Is All Hypocalcemia Due to Low Parathyroid Hormone?: An Unusual Case of Pseudohypoparathyroidism in a Young and Healthy Patient.

Pseudohypoparathyroidism is a rare disorder that is characterized by hypocalcemia and hyperphosphatemia that are unresponsive to the parathyroid hormone. We present a unique case of pseudohypoparathyroidism seen in a 33-year-old male who presented with abnormal laboratory findings including hypocalcemia, hypokalemia, hypomagnesemia, hyperphosphatemia, and positive Trousseau's sign. Pseudohypoparathyroidism is a rare phenomenon, with an estimated prevalence between 0.3 and 1.1 cases per 100,000. Genetic mutations have been noted to play a role in the presentation of pseudohypoparathyroidism. Clinical phenotypical manifestations can include brachydactyly, short stature, a stocky build, and a round face. Similar routine follow-up and treatment as traditional hypoparathyroidism is practiced. This case highlights a unique endocrinologic pathology that clinicians should be more aware of, as it can be confused with hypoparathyroidism.

Wernicke Encephalopathy in an Elderly Patient Due to Chronic Malnutrition From an Atypical Diet.

Wernicke encephalopathy has traditionally been associated with chronic alcohol abuse leading to thiamine deficiency. Clinical symptoms include mentation change, gait ataxia, and oculomotor abnormalities. However, it is often an underdiagnosed condition in patients suffering from chronic malnutrition, especially in the West. We examine a unique case of non-alcoholic Wernicke encephalopathy in an elderly patient. The patient had a long history of chronic malnutrition due to her atypical diet, consuming an unbalanced diet deprived of thiamine, unbeknownst to her. She presented with symptoms of encephalopathy, recurrent falls, and pupillary changes. After exhausting all other therapeutic interventions, she received a thiamine infusion; her mentation and other symptoms improved dramatically.  Thiamine deficiency can lead to severe complications, including Wernicke encephalopathy and cardiomyopathy. Wernicke encephalopathy can progress to Korsakoff syndrome, which is characterized by amnesia and confabulation. Case reports, such as ours, may remind clinicians to keep thiamine deficiency as a viable differential while evaluating acute encephalopathy, especially in the malnourished geriatric population.

Hyperhemolysis in the Setting of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel human pathogen known for its predilection on the respiratory system. Herein, we present a unique case in which a patient developed hyperhemolysis in the setting of mixed autoimmune hemolytic anemia (AIHA) secondary to SARS-CoV-2. A 33-years-old male with a past medical history of resolved immune thrombocytopenic purpura (ITP) presented to the hospital with symptoms of jaundice after being infected with SARS-CoV-2. On admission, his Hgb was 12.5 g/dL. Lab results showed indirect bilirubin of 13 mg/dL, LDH at 759 U/L, haptoglobin <10, and the percent reticulocyte count was 2.33%. A direct antiglobulin test (DAT) was also positive for C3, IgG, anti-E, in addition to both warm and cold autoantibodies. PCR was positive for COVID-19. Within two days of admission, his Hgb dropped to 5.9 g/dL. A total of seven units of packed red blood cell (pRBC) was required to achieve a Hgb of 6 g/dL in 48 hours. Patients with preexisting hematological abnormalities have a propensity to develop AIHA in the setting of the virus. The majority of the cases described in the literature were associated with warm AIHA. Our patient tested positive for both warm and cold antibodies, which may partially explain the mechanism behind hyperhemolysis in our patient.