Achalasia and Cricopharyngeal Sphincter Dysfunction in a Patient With Myasthenia Gravis: A Case Report.

This case report describes an 82-year-old female patient with myasthenia gravis (MG) who presented with worsening dysphagia. The patient was found to have cricopharyngeal sphincter and esophageal achalasia, and a percutaneous endoscopic gastrostomy (PEG) tube was placed due to severe pharyngeal dysphagia and cricopharyngeal dysfunction. The patient had class IVb myasthenia gravis and was treated with intravenous immunoglobulin (IVIG), prednisone, and pyridostigmine. The report discusses the link between myasthenia gravis and dysphagia, which is seen in 20% of patients. The report also explores the relationship between myasthenia gravis and achalasia, which is a rare disorder characterized by the failure of relaxation of the sphincter muscles. While myasthenia gravis leads to muscle weakness and should not cause achalasia, there have been a few case reports describing a link between the two disorders. Cricopharyngeal dysfunction, which is a common disorder causing dysphagia in the elderly, was also noted in the patient. The report highlights that cricopharyngeal dysfunction may be primary or secondary, with the latter often being associated with inflammatory myopathies such as polymyositis or mixed connective tissue disorders. The patient did not have a workup for other autoimmune diseases that could have been the cause of achalasia.

Pulmonary Glomus Tumor.

Glomus tumors, which account for less than 2% of soft tissue tumors, are a rare benign soft tissue neoplasm. They originated from neuro-myo-arterial glomus tissue whose primary function is regulation of the body temperature. This tissue is commonly located in the dermis or subcutis in the subungual region; however, it can be extracutaneous such as in bones, the genitourinary tract, the gastrointestinal tract, and the respiratory tract. Histologically, a glomus tumor is made of proliferating rounded or cuboidal epithelioid cells in a meshwork of blood vessels. Although a benign growth, they can rarely show malignant features with infiltration of surrounding tissue with the rapid multiplication of cells in which case it is labeled as a malignant glomus tumor. Pulmonary glomus tumors are extremely rare and most commonly occur in middle-aged men. They are mostly asymptomatic, but a small percentage of patients may present with hemoptysis and cough if there is large airway involvement. We present an interesting case of a middle-aged man presenting with cough and occasional hemoptysis, found to have an endobronchial nodular lesion, and subsequently diagnosed with a pulmonary glomus tumor.

Brain Abscesses by Nocardia: An Interesting Case.

The successful management of disseminated Nocardia infection is not well described in medical literature. Immunocompetent individuals presenting with complicated and widespread Nocardia infection is an uncommon phenomenon. We describe an interesting case of a large Nocardia abscess in the brain in an immunocompetent patient that was aspirated. The patient clinically improved and was discharged home on a prolonged course of intravenous antibiotics and close outpatient follow-up. He successfully finished the antibiotic therapy for one year, and repeat imaging studies suggested the resolution of the abscess. With this case, we also intend to do a brief literature analysis about the management of brain abscess caused by Nocardia species.