Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) are a relatively new class of medications used for the management of type II diabetes mellitus targeting the kidneys. Within the last decade, several warnings have been issued regarding the development of severe genitourinary infections, including necrotizing fasciitis, or Fournier's gangrene, in those with pre-existing type II diabetes and concomitant use of this drug class.Objective: The purpose of this review is to highlight and discuss the factors contributing to the development of Fournier's gangrene, its pathogenesis, and a review of existing literature describing patient outcomes, treatment, and future directions regarding early detection of this complication.Methods: Articles and studies addressing effective treatment adherence and key factors contributing to Fournier's gangrene with SGLT2 inhibitors were identified by effective keyword searches in PubMed Central, Google Scholar, and Cochrane, as well as the references found within these articles.Results: Using the keywords provided, 55 case reports, review articles, and meta-analysis reports written within the last 20 years were utilized as the source of the data presented in this systematic review article.

Cavitary lesions of the lungs are a very frequent picture found in clinical practices resulting from a wide range of pathological processes with variable duration of formation depending on infectious pathogens. Common organisms causing cavitary lesions are Staphylococcus aureus , Klebsiella pneumoniae , Streptococcus pneumoniae , Haemophilus influenzae , typical and atypical Mycobacterium , and Aspergillus . Herein, we are presenting a case that developed cavitary lesions in both lungs colonizing Acinetobacter , a rare causative agent, within less than two months of a positive coronavirus disease 2019 (COVID-19) infection.

Colorectal carcinoma has increasingly been reported to be associated with gut microbial dysbiosis. Bacteroides , Fusobacterium , Faecalibacterium , Blautia , etc., are gut microbes commonly associated with colorectal carcinoma. Gut microbial dysregulation secondary to infectious, inflammatory, toxin exposure or change in dietary habits coupled with the disruption of the inner mucosal layer overlying the luminal epithelium is hypothesized as the inciting events leading to microbial invasion and subsequent tumorigenesis. Although the precise mechanism is unclear, disruption of normal host responses like inflammation, apoptosis, cellular proliferation, free radical injury, production of oncogenic toxins, etc., is postulated to play a role. We report a case of Veillonella bacteremia in a patient with metastatic colorectal carcinoma without a preceding history of periodontal disease. The patient was managed with ampicillin-sulbactam, which was followed by subsequent negative blood cultures. This case report signifies the association of gut microbiota like Veillonella with colorectal carcinoma and the importance of subsequent screening for colorectal cancer following Veillonella bacteremia .

Acute pyelonephritis (APN) is considered a rare cause of acute kidney injury (AKI), especially when no anatomical abnormalities or predisposing factors are identified. Additionally, non-obstructive pyelonephritis is a very infrequent cause of rapidly progressive acute kidney injury. Herein, we present a rare case of a 55year-old female patient who was diagnosed with acute non-obstructive pyelonephritis leading to AKI eventually requiring hemodialysis. The patient eventually recovered with the administration of intravenous antibiotics with a significant recovery of renal function.

Cocaine use can result in a few infrequent complications, among which is localized hematoma. As far as we know, there are very few cases reporting cocaine-induced non-traumatic muscle hematoma complicated by severe transaminitis and rhabdomyolysis. Here we present a patient who developed a significant lower extremity muscle hematoma secondary to inhalational cocaine use. We are reporting this case to bring to light this rare and unusual complication of cocaine use. With recreational use of this drug being so prominent in the patient population, early recognition of this complication can help expedite treatment and reduce the severity of end-organ damage.

Acute cholecystitis may present cardiovascular manifestation like cardiac ischemia leading to detailed cardiac workup without any obvious cardiac pathology. Here we describe a case who presented with typical signs and symptoms of cholecystitis exhibiting sinus bradycardia. This reflexive bradycardia was a result of autonomic vagal innervation and was resolved after cholecystectomy. This case highlights the importance of the cardio-biliary reflex and recommends clinicians ensure expedited management of cholecystitis to avoid unnecessary extensive cardiac workup.

Tissue plasminogen activator (tPA) and recombinant deoxyribonuclease (DNase ) are used in treating pleural infection due to their mucolytic activity by effectively reducing pleural fluid viscosity. The combination of tPA and DNase has attracted considerable interest as an alternative to surgical intervention for treating complicated parapneumonic effusion in high-risk patients who are not good candidates for surgery. However, intrapleural hemorrhage has been reported as a villainous outcome in a few cases which needs to be considered as a differential diagnosis with sudden clinical deterioration after the therapy. Here, we report the case of a patient who presented with pneumonia and later developed a large right complicated parapneumonic pleural effusion. A chest tube was placed with drainage of fluid while tPA and DNase were also considered as an additional treatment module. Following the first dose of DNase and tPA, the patient developed hypoxemia with hypotension and was found to have rapid development of white-out right hemothorax.

No abstract