The Incidental Discovery of an Ileal Conduit Calculus: A Case Report.

In patients who have undergone radical cystectomy, urinary diversion procedures such as ileal conduits may pose a considerable problem for urologists when they result in stone formation. While an ileal conduit stone is only one of many potential complications of this procedure, its management may be particularly challenging; symptoms and treatments vary depending on factors such as stone location, composition, and the patient's BMI. We present a unique case of a 91-year-old male with a history of prostate and bladder cancer status post-radical prostatectomy, cystectomy, and ileal conduit who presented to the emergency department complaining of abdominal pain, nausea, vomiting, and disorientation for the last 24 hours. The patient was diagnosed with a complete bowel obstruction secondary to gallstone ileus. Consequently, an exploratory laparotomy was performed, which revealed that his small bowel obstruction was not caused by gallstone ileus but rather secondary to an internal hernia and volvulus associated with a previous bowel resection and anastomosis. The stone that was originally thought to be causing the small bowel obstruction turned out to be a 3.3 cm stone in his ileal conduit, which ultimately had no part in causing the patient's small bowel obstruction. Calculus formation is an infrequent complication of ileal conduit placement. Our aim in presenting this case is to increase awareness of this rare complication that can arise without symptoms with the hopes of increasing early intervention and improving outcomes.

Lipschütz Ulcers: Classic Presentation of an Uncommon Condition.

We describe the case of a 17-year-old female who presented with the acute onset of painful genital ulcers after experiencing a week of flu-like symptoms. A physical exam revealed two 1 cm necrotic ulcers on the right vulva with an erythematous margin and overlying exudate. A diagnosis of Lipschütz ulcers was made based on the classic signs and symptoms, in addition to ruling out relevant infectious and inflammatory diseases. Our goal in presenting this case is to add to the literature and increase awareness regarding this uncommon condition. The differential diagnosis and workup for genital ulcers can be extensive, but when diagnosed correctly, treatment and reassurance can provide great comfort for the patient.

Myocardial Bridging as a Differential Diagnosis for Myocardial Infarction: A Case Report.

We present a case of a 55-year-old male who presented to the emergency department with complaints of acute onset of chest pain. As part of the workup, an electrocardiogram (ECG) revealed ST-segment elevation in leads V1-V5. Upon cardiac catheterization, myocardial bridging of the left anterior descending (LAD) artery was discovered without evidence of any obstructive coronary artery disease. The purpose of this report is to add to the existing literature that myocardial bridging, although traditionally thought to be a benign pathology, can also present risks for ischemia and infarction.

Variability of Steroid Response Time in Polymyalgia Rheumatica: A Case Report.

We present a unique case of a 75-year-old Caucasian female who presented with a two-month history of unrelenting proximal muscle pain and stiffness in the neck, shoulders, and pelvic girdle that lasted for 45 minutes each morning upon waking. Due to clinical suspicion of polymyalgia rheumatica (PMR), the patient was started on the standard therapy of low-dose glucocorticoid therapy and was noted to have a dramatic improvement in terms of pain, strength, mobility, and range of motion. Current literature shows high variability in the standard response time to treatment. Typical resolution of symptoms occurs within a span of one day to months. The case presented in our study shows symptom resolution as well as marked improvement in muscle strength and mobility within 12 hours. The purpose of this case report is to provide additional information for physicians when considering symptom-resolution time related to low-dose glucocorticoid therapy and PMR. Additionally, we briefly explore the literature on the correlation between giant cell arteritis (GCA) and glucocorticoid therapy for PMR as well as the data associated with adjuvant therapy using immunomodulatory treatment.

Evaluating Acute Bilateral Foot Drop: A Case Report.

We illustrate the case of an 84-year-old Caucasian female who presented with complaints of bilateral lower extremity weakness and ambulation difficulties complicated by a unilateral deep venous thrombosis. Physical examination on hospital admission revealed an acute onset of bilateral foot drop with pes cavus deformity. Bilateral foot drop has been associated with a more chronic presentation due to metabolic, neurologic, and musculoskeletal etiologies. Acute onset of bilateral foot drop has been poorly defined in the literature and is considered a rare pathologic phenomenon, requiring additional investigation into the underlying cause of the presentation. We hypothesize that a spinal cord compression at the T12-L1 level resulted in L5 nerve root compression, resulting in our patient's presentation. Definitive treatment has not been established for this condition; however, studies have been completed to evaluate surgical versus conservative approaches to help restore patients' ambulatory function. Our aim is to incorporate this case report into the limited current literature on acute bilateral foot drop as well as outline possible treatment methods to restore impaired functionality.