We present a case of a 78-year-old African-American man with a history of hypertension, and with no prior history of seizure. The patient presented with hypertensive urgency as well as stroke such as symptoms of confusion, seizure, postictal confusion, left hemianopsia and hyponatraemia. MRI findings were suggestive of posterior reversible encephalopathy syndrome (PRES). The patient was treated with appropriate medications with the resolution of his stroke-like symptoms. This case report discusses a patient with PRES, in the setting of hyponatraemia, and how prompt recognition may prevent permanent neurological sequela such as epilepsy.

Signet ring cell carcinoma (SRCC) is a subtype of adenocarcinoma. It can arise in different organs including stomach, colon, bladder, prostate and breast. The vast majority of SRCC found in the pulmonary system is metastatic. Primary disease to the lungs is rare. The main feature of this type of malignancy is mucin-producing cells. It has been reported that out of 3500 cases of pulmonary adenocarcinoma, five cases had features of SRCC.

In the present case a 30-year-old African American man was admitted with fever and chills secondary to two large hepatic abscesses diagnosed on an ultrasound. The patient was started on antibiotics after blood cultures were drawn. Initially the abscess was drained and showed dramatic improvement upon repeat imaging. The blood cultures revealed Gram-negative rods that were identified as Fusobacterium necrophorum. At that time the patient was switched to levofloxacin and metronidazole based on sensitivities. On this new antibiotic regime the patient improved dramatically. After just 5 days the patient was discharged home on oral antibiotics and was scheduled to follow-up in 1 week. In the present case we present a healthy 30-year-old man with no significant co-morbidities who developed a hepatic abscess from F necrophorum but successfully recovered after appropriate antibiotic treatment.

In the present case, a 49-year-old white female presented to the clinic with a 2-month history of nausea, vomiting, and right upper quadrant pain. On examination a 3-cm mass on the right anterior scalene muscle was noted. A computed tomography scan was performed revealing a 8.7 × 7.7 × 6.1 cm retroperitoneal mass with possible invasion of the inferior vena cava and right renal and left common iliac veins. An excisional biopsy was performed with pathology compatible with spindle cell sarcoma. The patient was then sent for follow-up at the sarcoma clinic as an outpatient. However, before chemotherapy was to be started the patient would be admitted to the hospital with progressively worse nausea and vomiting. At that time the patient’s lab work showed lactic acidosis, acute renal failure, hyperuricemia, hyperphosphatemia, and hypocalcemia, which met the Cairo–Bishop criteria for tumor lysis syndrome (TLS). The patient was admitted to the intensive care unit and kidney dialysis initiated. The patient would become progressively obtunded at which time the family opted for hospice care. The patient eventually succumbed peacefully 3 days after her last admission. In this case report, we briefly review the literature on TLS in solid tumors, and we present a rare case of spontaneous TLS in a retroperitoneal sarcoma.