A Case of Hepatitis C Related Mixed Cryoglobulinemia Syndrome.

Hepatitis C virus (HCV) is an RNA virus that preferentially infects hepatocytes and is transmitted through infected blood contact. Chronic hepatitis C can result in serious life-threatening conditions like fibrosis, cirrhosis, and liver cancer. Additionally, it can result in extrahepatic conditions including lymphoproliferative disease and mixed cryoglobulinemic vasculitis. Mixed cryoglobulinemic vasculitis occurs as a result of immune system dysfunction leading to immunoglobulin deposits into different blood vessels in the body. The main manifestations commonly seen are purpura, weakness, arthralgias. Other symptoms include peripheral neuropathy, arthritis, vasculitic skin ulcers, liver, and renal involvement. This case highlights a 57-year-old male with a medical history of substance use disorder, bilateral lower extremity ulcers, and chronic hepatitis C infection who presented with complaints of bilateral lower extremity wounds, abdominal distension, and scrotal swelling. Our patient was confirmed to have new-onset cirrhotic liver secondary to intravenous drug use, with worsening renal function. Further investigations confirmed the diagnosis of mixed cryoglobulinemia secondary to hepatitis C virus.

A Rare Case of Pancreatic Ascites Secondary to Chronic Pancreatitis.

Pancreatic ascites refer to continuous leakage of pancreatic secretions in the peritoneum leading to accumulation of pancreatic fluid in the peritoneal cavity. Although literature on the incidence of pancreatic ascites and presenting signs and symptoms is scarce, it may be seen in patients with chronic alcoholic pancreatitis. Patients typically present with acute chronic pancreatitis and new-onset ascites, with or without abdominal pain. A diagnostic paracentesis is usually the first step to determine the etiology of the ascites. Mild cases may resolve with conservative management. Optimization of nutrition status is an important factor to reduce morbidity and mortality. More severe cases or cases refractory to conservative management may require endoscopic or surgical intervention. This case report describes a rare presentation of pancreatic ascites in a 35-year-old female.

A Case of Adult Clival Osteomyelitis.

Clival osteomyelitis is a potentially life-threatening skull base infection. It is rare and generally challenging to diagnose and treat. Clival osteomyelitis is typically seen in the pediatric population and is very rare in the adult population. It occurs as a complication of recurring paranasal infections and malignant otitis externa. The exact pathophysiology of osteomyelitis of the clivus is relatively uncertain. Here, we describe a case of a 36-year-old man with medical history significant for hypertension and poorly controlled type 1 diabetes mellitus who experienced recurrent paranasal sinus infection for 2 years. He received multiple antibiotic treatments and underwent adenoidectomy without substantial improvement of symptoms. Ultimately, a diagnosis of the clival osteomyelitis through the help of a computed tomography (CT) scan of the paranasal sinus and neck was made. This diagnosis allowed for adequate intervention and treatment of our patient with subsequent resolution of his presenting symptoms. This case highlights the importance of high suspicion for clival osteomyelitis in patients with recurring sinus infections.

Reactive Thrombocytosis after Splenectomy in Hereditary Spherocytosis: Case Report and Literature Review.

Reactive thrombocytosis after splenectomy is a feared cause of thrombosis throughout the arterial and venous system. There are many causes of splenomegaly, ranging from cirrhosis to lymphoma to hereditary spherocytosis. In this report, we will discuss a case of reactive thrombocytosis after splenectomy in a patient with hereditary spherocytosis. Splenomegaly is a relatively common finding in HD patients, causing extravascular haemolysis and thus leading to haemolytic anaemia. Splenectomy is usually considered when patients start to manifest severe symptoms such as abdominal pain, jaundice or worsening liver function tests. Our patient was a good surgical candidate and successfully underwent splenectomy but afterwards developed arterial and venous thrombosis due to reactive thrombocytosis. An extensive hypercoagulable work-up was unremarkable. The patient was started on hydroxyurea and anticoagulation with eventual improvement of platelet levels. LEARNING POINTS: Reactive thrombocytosis can be a significant complication after splenectomy and can range from mild (500,000-700,000/mm3), to moderate (700,000-900,000/mm3), severe (>900,000/mm3) and very severe thrombocytosis (>1,000,000/mm3).The use of low-dose hydroxyurea in patients with very severe thrombocytosis can reduce the platelet count to safe levels, and thus, the risk of developing thrombosis.

Acute Pancreatitis Induced Splenic Vein Thrombosis.

Acute inflammation of the pancreas, known as pancreatitis, can result in many complications ranging from acute distress respiratory syndrome to pancreatic necrosis. A relatively common vascular complication of pancreatitis is splenic vein thrombosis (SVT) due to intimal inflammation leading to platelet aggregation and thrombosis. The management of SVT with regard to anticoagulation (AC) might appear to be perplexing at first given the recommendation to withhold any sort of AC. Research studies have shown that these patients have an increased risk of gastrointestinal bleeding without AC. In this report, we discuss a case of hypertriglyceridemia-induced pancreatitis. During hospitalization, our patient complained of worsening abdominal pain with objective fevers and leukocytosis in which CT scan of the abdomen was significant for hemorrhagic pancreatitis with necrosis, acute SVT, and splenomegaly. The patient was managed conservatively with IV fluids, pain relief medications, and antibiotics.

Oxcarbazepine-Induced Hyponatremia: A Case Report and Comprehensive Literature Review.

Oxcarbazepine is a well-known and effective anti-convulsant used for patients with underlying seizure disorder. It is a structural analog of carbamazepine; however, it follows a different metabolic pathway in which it is converted to a different active metabolite. Side effects associated with this medication are vast; however, in this report, we will hone in on the renal adverse effects, e.g., syndrome of inappropriate anti-diuretic hormone secretion (SiADH). SiADH is a condition in which the body is making too much anti-diuretic hormone, which, in turn, results in "too much" water absorption, causing hyponatremia with neurologic sequelae. Our patient is a 31-year-old gentleman with a history of depression, anxiety, bipolar disorder, and previous suicide attempts who presented to the emergency department following oxcarbazepine overdose and was subsequently found to be hyponatremic secondary to having SiADH.