Fatal Cat Scratch Disease in Alcoholic Patient With Liver Cirrhosis: A Case Report.

Cat-scratch disease (CSD), a human infection resulting from Bartonella species, commonly manifests as tender lymphadenopathy. Consequently, its inclusion in the differential diagnosis of fevers of unknown origin and lymphadenopathy syndromes is imperative. Typically, it manifests as self-limiting tender lymphadenopathy and does not lead to fatalities, though it may assume a more severe course in immunocompromised individuals. Diagnostic challenges often surround CSD due to its elusive nature in laboratory tests, necessitating a reliance on the clinical presentation for definitive diagnosis. This can manifest in delayed procedures and testing, which can prolong intervention and cause rapid progress of bacteria, potentially causing severe complications and death. In this case report of a 58-year-old Caucasian male, we delve into the clinical presentation and eventual fatality of CSD in a patient with liver cirrhosis, occurring in the United States. He sought care in the emergency department due to lethargy, fever, and swollen axilla following a cat scratch. Although the patient did not exhibit signs of sepsis upon admission, he rapidly progressed to sepsis and passed away within 24 hours. This case highlights the significance of timely and proactive management in individuals presenting with CSD, especially when complicated by underlying immunocompromised conditions. Early recognition, the administration of suitable antibiotics, and comprehensive supportive care are pivotal in averting fatal outcomes in such cases.

Case of Circulating Tumor Cells Discovered in Extensive Deep Venous Thrombosis in a Patient with Known Urothelial Carcinoma.

Background: Currently, minimal data are available to explore the composition of venous thromboembolism in patients with cancer. This case report discusses a presentation of venous thromboembolism in a patient with high-grade urothelial carcinoma and highlights the pathology findings in thrombi. Case Presentation. A 55-year-old female who was diagnosed with high-grade urothelial carcinoma with multiple metastases developed an extensive deep vein thrombosis in her left lower extremity. Endovascular revascularization was indicated due to left lower extremity pain and swelling not responsive to anticoagulation. A mechanical thrombectomy was performed, and samples were sent for pathology. Pathologic examination discovered minute fragments of metastatic carcinoma, admixed with laminated blood clots (thrombus). The morphology of metastatic carcinoma and the immunostain profile were compatible with metastatic carcinoma of bladder origin. Conclusion: Cancer is a well-known risk factor for developing VTEs, and it is estimated that approximately 4-20% of cancer patients will experience VTE at some stage, the rate being the highest in the initial period following diagnosis. Annually, 0.5% of cancer patients will experience thrombosis compared with a 0.1% incidence rate in the general population (Elyamany et al., 2014). Despite knowing the increased incidence of VTEs in cancer patients, there are few studies to date that analyze the composition of thrombi in patients with cancer.

Emergence of Rapid-Onset Ototoxicity Following Three Doses of Vancomycin: A Unique Case Report in the Context of Normal Renal Function and Therapeutic Dosing.

Vancomycin, a potent glycopeptide antibiotic renowned for its efficacy against methicillin-resistant Staphylococcus aureus, also harbors the potential for adverse reactions. While its use is often associated with infusion-related events and nephrotoxicity, ototoxicity has emerged as a noteworthy but rare concern. This adverse effect, characterized by a spectrum of transient to permanent hearing loss or damage, typically surfaces in patients receiving excessive doses, those undergoing concomitant therapy with other ototoxic agents such as aminoglycosides, or individuals with baseline hearing impairment or renal dysfunction. This report highlights the possibility of ototoxicity in the setting of normal renal function and therapeutic dosing. We report a case of a 58-year-old male patient with a complex medical history, who presented with sepsis, respiratory failure, and a constellation of underlying conditions. His treatment regimen encompassed intravenous vancomycin administration, which led to an unexpected development-severe-to-profound bilateral conductive and sensorineural hearing loss after three doses. The absence of concurrent ototoxic agents and Bayesian dosing software predicting an acceptable AUC/MIC ratio complicates the understanding of this adverse event. Amid this complex scenario, the case underscores the evolving landscape of vancomycin-induced ototoxicity, encouraging heightened vigilance, thorough audiometric monitoring, and an in-depth exploration of potential mechanisms underlying this adverse reaction. Early audiometric testing and referral to otolaryngology may allow for early intervention with high-dose steroids to mitigate the ototoxicity.

Exemestane-Everolimus-Induced Angioedema in a Woman With Metastatic Breast Cancer: A Case Report and Review.

Dual exemestane-everolimus therapy has been shown to confer a progression-free survival benefit in women with refractory advanced hormone-receptor-positive breast cancer. Patients with breast cancer may experience several other comorbidities, including hypertension, for which angiotensin-converting enzyme inhibitors (ACE-I) are a first-line therapy for hypertension of cardiovascular and/or renal etiology. One rare but feared side effect of ACE-I is severe angioedema due to decreased bradykinin degradation, which can lead to respiratory collapse. Several single-center case series have previously suggested that the use of everolimus in conjunction with ACE-I may lower the threshold for angioedema development. We report our experiences managing a 71-year-old with metastatic breast carcinoma and hypertension who presented with severe angioedema after the combined use of exemestane-everolimus with lisinopril.

Breathless Revelation: Unmasking Acute Myeloid Leukemia Through Acute Respiratory Failure.

Establishing a diagnosis of acute myeloid leukemia (AML) in a patient presenting with acute respiratory failure is rare. Here, we present a case of AML initially appearing as hypoxemic respiratory failure linked to presumed community-acquired pneumonia. This case report unravels the intricate diagnostic odyssey of an atypical AML presentation masquerading as an acute respiratory failure, accentuating the multifaceted challenges clinicians encounter in discerning the actual underlying pathology amidst the haze of mimicry. Upon meticulous diagnostic expedition, infection was ruled out as a cause of respiratory failure, and the patient underwent a malignancy workup, ultimately culminating in the diagnosis. This case underscores the importance of broader diagnostic vigilance. Comprehensive assessments, combined with interdisciplinary collaboration, emerged as crucial for accurate diagnosis, emphasizing the need to consider hematologic pathologies despite seemingly unrelated clinical presentations.

Rare Case of a Clival Chondroma Resulting in Panhypopituitarism.

Chondromas are rare benign tumors composed of hyaline cartilage that can arise in various locations in the body. Their occurrence in the clivus, leading to panhypopituitarism, is exceptionally rare. This case report describes a 93-year-old female with a known clival chondroma who presented with altered mental status, presumed to be secondary to toxic metabolic encephalopathy due to an infectious cause. Further diagnostic evaluation revealed pituitary hormone levels below the normal range. This case report aims to highlight a unique case of panhypopituitarism attributed to a chondroma in the clivus with tumor extension to the sellar region, emphasizing the diagnostic challenges and treatment options for this unusual pathology.

Reactive Peri-Arthroplasty Pseudotumors: A Rare Cause of Hip Pain and Iatrogenic Sciatica.

Total hip arthroplasty (THA) is the preferred treatment for patients with hip joint disorders refractory to conservative management. While original implants were designed to articulate a metallic femoral head onto a polyethylene liner, the popularity of "metal-on-metal" (MoM) hip implants surged in the early 21st century due to their perceived superior long-term durability and lower revision rates. However, subsequent follow-up studies showed high failure rates due to inflammatory responses to periprosthetic metallic debris leading to lymphocytic proliferation, soft tissue necrosis or fibrosis, systemic metal toxicity, and/or the development of cystic pseudotumors. Although these discoveries resulted in a significant decrease in MoM THA and revision procedures, the majority of MoM hip implants persist in the adult population. In this case report and review, we report the presentation, diagnostic work-up, and management of an 84-year-old status-post MoM THA who presented with unilateral leg tenderness and poor ambulation secondary to pseudotumor-induced sciatica.

Unraveling the Enigma of Belly Dancer's Dyskinesia: A Detailed Case Analysis in the Context of Schizophrenia.

Belly dancer's dyskinesia (BDD) is an unusual neurological disorder characterized by focal dyskinesia that results in involuntary, rhythmic movements of the anterior abdominal wall. This case report comprehensively examines the presentation, potential medication-induced etiology, and therapeutic response of a 64-year-old male diagnosed with schizophrenia. The patient developed BDD-like symptoms resembling hiccups, experiencing recurrent episodes that endured for hours and occurred nearly daily, significantly affecting wakefulness and sleep. Importantly, the patient's medical history included the utilization of fluphenazine and benztropine for schizophrenia management. Following a thorough multidisciplinary neurology consultation, a tailored treatment regimen involving clonazepam, promethazine, and baclofen was initiated, culminating in a noteworthy reduction in symptom frequency. This report substantially enriches the existing knowledge of BDD, highlighting the critical necessity to elucidate its intricate pathophysiology for the advancement of refined diagnostic and therapeutic strategies.