Elevated levels of AST, ALT, and CPK · no family history of liver disease · Dx?

A 26-year-old healthy male veteran with bipolar disorder and post-traumatic stress disorder was referred for a gastroenterology consultation after a routine laboratory evaluation revealed elevated levels of aspartate aminotransferase, 1040 IU/L (normal range, 10-40 IU/L), and alanine aminotransferase, 334 IU/L (normal range, 7-56 IU/L). He had been taking divalproex and ziprasidone for the previous 2 years, during which time liver test results had been normal.

Pleural Myiasis Associated With Pleural Angiosarcoma.

Myiasis refers to a parasitic infestation of vertebrate mammals by dipterous larvae (maggots) of higher flies. Infections in humans typically occur in tropical and subtropical regions, regions with limited medical access, and areas with poor hygiene and living conditions. Infestations in humans have been described in subcutaneous, nasal, ocular, oropharyngeal, and orotracheal cases; however, reports of pulmonary myiasis in humans in the United States and other developed countries are extremely rare. We describe a patient with recently diagnosed primary pleural angiosarcoma who presented to our clinic for the management of a thoracostomy tube and was diagnosed with pleural myiasis.

Obstructive uropathy secondary to rectus sheath hematoma.

Rectus sheath hematoma (RSH) is uncommon and is often reported in the setting of anticoagulation or trauma. Typically RSH presents with localized or diffuse abdominal pain and a fixed abdominal wall mass, however, various presentations and complications have been reported depending on the setting and extent of the hematoma. We report a case of a rapidly expanding RSH causing obstructive anuria and hydronephrosis in addition to a review of literature on this rare presentation of RSH.