Complications and Management of a Rare Case of Disseminated Coccidioidomycosis to the Vertebral Spine.

Coccidioidomycosis, also known as San Joaquin Valley Fever or Valley Fever, is mostly a pulmonary infection caused by inhalation of spores in an endemic region. Dissemination to bone, joints, meninges, and skin occurs less than one percent of the time. Skeletal involvement accounts for approximately half of the disseminated coccidioidomycosis with the vertebrae as the most common skeletal region. We present a very rare case of disseminated coccidioidomycosis with osteomyelitis and compression fracture of the lumbar vertebral body. This case depicts some of the potential issues that can arise in managing coccidioidomycosis, especially when noncompliance to initial azoles occurs, that can lead to dissemination and complicated bone infections necessitating surgical intervention along with continuous medical therapy.

A Rare Case of Primary Anterior Mediastinal Yolk Sac Tumor in an Elderly Adult Male.

Mediastinal germ cell tumors are extragonadal germ cell tumors (EGGCTs) commonly seen in children and young adults. They are more common in men. Clinically they are classified as teratomas, seminomas, and nonseminomatous germ cell tumors. Primary mediastinal yolk sac neoplasm is an extremely rare tumor. We present here a very rare case of primary yolk sac tumor of the anterior mediastinum in a 73-year-old male. Mediastinal germ cell tumors have a worse prognosis than gonadal germ cell tumors. Chemotherapy followed by adjuvant surgery improves overall response in EGGCTs. However, comorbidities can render treatment with chemotherapy and surgery challenging in elderly patients.

Poorly Differentiated Neuroendocrine Tumor of the Rectum Coexistent with Giant Rectal Villous Adenoma Presenting as McKittrick-Wheelock Syndrome.

McKittrick-Wheelock Syndrome is a rare disorder, noted for electrolyte and fluid depletion caused by secretory colorectal adenomas and carcinomas. We report here the first reported case of a 55-year-old man with a large rectal villous adenoma coexistent with a poorly differentiated neuroendocrine tumor of rectum presenting with McKittrick-Wheelock Syndrome. Palliative chemotherapy resulted in complete resolution of symptoms and improved quality of life.