The Feline and the Swine: A Peculiar Case in an Allergy Clinic.

Cross-reactivity between mammalian proteins, such as that in Pork Cat Syndrome, remains a topic of great interest. This syndrome, characterized by an immunoglobulin E (IgE)-mediated response to porcine albumin triggered by sensitization through cat epithelium, has been sparsely documented. We discuss a 41-year-old female who developed a pruritic rash within 30 minutes of consuming pork. Notably, she exhibited elevated serum IgE levels with specific reactions to cat dander, dog dander, and pork. A skin prick test for pork was positive. The patient was treated conservatively with allergen avoidance, vitamin D supplementation, fexofenadine, and doxycycline for systemic reactions, and topical corticosteroids for localized skin reactions, yielding a resolution of symptoms. This case underscores the significance of recognizing rare cross-reactivities in allergy and immunology and the manifestations of Pork Cat Syndrome, necessitating a comprehensive patient history and awareness for improved diagnosis and management.

Ciguatera Toxin Syndrome from Amberjack Ingestion as a Cause of Chronic Dermatitis with Episodic Erythema.

Bioaccumulation of naturally produced ciguatoxin (CTX), such as that in ciguatera poisoning, continues to be a subject of great interest. In this condition, CTX is ingested by subtropical and tropical reef fish. Humans consume the fish species, and CTX is absorbed through the gastrointestinal tract and binds voltage-gated sodium channels on nerve terminals to cause neurological, gastrointestinal, cardiac, and rare dermatological clinical manifestations. In this present case, we discuss a 65-year-old female who presented with acute loose bowel movements and generalized pruritus of her anterior chest wall, abdomen, and bilateral upper and lower extremities 48 hours after consumption of amberjack fish. The patient was treated with intravenous corticosteroids and epinephrine and discharged with an oral corticosteroid taper. After appropriate treatment protocol, the patient continued to have pruritus with a burning sensation in her extremities with a rare skin dermatitis. Subsequent treatment included topical corticosteroids and moisturizing lotion to create a skin barrier, fexofenadine for pruritus control, and gabapentin and amitriptyline for paresthesia. This case demonstrates the need for continued research and patient education into the broad clinical manifestations that present as life-altering ciguatera poisoning.

A Rare Case of Sinonasal Ewing Sarcoma With Radiologic-Pathologic Correlation.

An 89-year-old male presented with syncope and worsening difficulty in breathing through the left nostril. Computed tomography demonstrated a tumor in the anterior ethmoid air cells and maxillary sinus, which extended into the frontal lobe. Magnetic resonance imaging similarly demonstrated an aggressive lesion. This mass was difficult to differentiate from more commonly seen lesions at this location such as an esthesioneuroblastoma or nasopharyngeal carcinoma. Direct visualization, biopsy, and subsequent pathologic analysis eventually confirmed the diagnosis of malignant Ewing sarcoma (EWS). Our case explores the radiological findings of EWS originating from the ethmoid sinus, compares EWS with other common carcinomas in the same location, confirms the diagnosis through pathological correlation, and investigates the prognosis and treatment of these lesions. This case highlights the importance of a multidisciplinary approach to diagnose EWS when it occurs in an atypical location. The clinical team relied on input from the radiology, surgery, ENT, neurology, and pathology departments to make an accurate diagnosis and plan treatment for this aggressive tumor.

Bilateral Optic Disk Swelling and Peripheral Visual Field Defects as a Rare Initial Presentation of Primary Chiari I Malformation.

Chiari malformation 1 (CM1) is defined as a herniation of encephalon matter through the base of the skull. The amount of herniation is cited as greater than 3 mm or 5 mm, depending on the source of literature. We report a rare case of a 55-year-old male initially presenting with bilateral papilledema and monocular right lower quadrantanopia, found to have CM1. An MRI confirmed 4.87 mm herniation of the cerebellar tonsils at the foramen magnum, and he was diagnosed with CM1. He was later found to have a normal opening pressure on lumbar puncture at 10 cm H2O. This poses an interesting clinical question as papilledema is defined by elevated intracranial pressure. The ophthalmic defects of this patient with normal intracranial pressure and CM1 are explored in this report.

A 20.5 cm Malignant Peripheral Nerve Sheath Tumor of the Anterior Mediastinum Showing Response to Neoadjuvant Therapy.

Malignant peripheral nerve sheath tumors (MPNST) are a rare form of sarcoma derived from Schwann cells. Major risk factors for development are neurofibromatosis 1 (NF1) and prior radiation exposure. Tumor location is highly variable. We present a case of an extremely large MPNST tumor in the anterior mediastinum in a 66-year-old male. To the best of our knowledge, the 20.5 cm tumor is the first of its kind in a patient without clinical signs of NF1 or prior radiation exposure. The localization of this tumor to the anterior mediastinum is rarer, as the most common tumors presenting in this area are thyroid neoplasms, thymomas, teratomas, and lymphomas. The patient's tumor responded to doxorubicin-ifosfamide-mesna-based therapy. The tumor decreased from 20.5 cm to 9.0 cm on subsequent imaging. Thus, this is an interesting and valuable case to learn about the presentation and potential treatments of such a rare pathology.