Hepatocellular carcinoma is the most common primary liver malignancy. Risk factors as viral infection, obesity, excessive alcohol use, and tobacco use are associated with the development of hepatocellular carcinoma. Hepatocellular carcinoma presentation ranges from asymptomatic to upper abdominal pain along with lethargy, weight loss, nausea, and anorexia. Different staging systems has developed in the past to stage hepatocellular carcinoma. Many treatment approaches have been used for HCC including chemotherapy, immunotherapy, ablation therapy, surgery, and liver transplantation.
The 2019 coronavirus disease (COVID-19) can present with a wide variety of clinical manifestations, including a hypercoagulable state leading to both arterial and venous thrombosis. Portal vein thrombosis (PVT) in the setting of COVID-19 has rarely been reported in the medical literature. Pylephlebitis with concomitant liver abscess is a rare complication of intra-abdominal infection. Here, we present the case of a 49-year-old man who initially presented with intermittent fevers and generalized weakness of 1-month duration and was subsequently found to have COVID-19 infection, PVT, and Bacteroides fragilis bacteremia with associated pyogenic liver abscess. The patient was treated with intravenous antibiotics and oral anticoagulation with plan to follow up outpatient with gastroenterology in 3 months to ensure resolution of PVT and liver abscess.
We describe the case of an elderly female, with no prior history of thyroid dysfunction, who presented with facial swelling and worsening fatigue. She was found to have myxedema coma, with thyroid-stimulating hormone (TSH) 98.90 uIU/mL and free thyroxine (fT4) 0.8 ng/dL, following two months of amiodarone therapy for paroxysmal atrial fibrillation. The patient developed cardiogenic shock and received liothyronine, levothyroxine, stress dose steroids, inotropic and vasopressor therapy while in the intensive care unit (ICU). She was weaned off vasopressors and switched to oral levothyroxine with a gradual steroid taper. Two months following hospital discharge, the patient remained asymptomatic while on oral levothyroxine. Literature lacks cases of amiodarone-induced myxedema coma and to our knowledge, myxedema coma secondary to amiodarone use has never been reported in patient on treatment for as short as two months. This case demonstrates the significance of early diagnosis and prompt treatment for rapid progression of signs and symptoms of amiodarone-induced myxedema coma to optimize outcomes. Although transient changes are seen while on amiodarone therapy, continuous monitoring is essential to examine for apparent thyroid dysfunction. Thyroid function testing prior to initiation of amiodarone and in cases of cardiac dysrhythmias or cardiogenic shock can help to avoid potentially fatal complication of hypothyroidism.
Isolated pancreatic metastases from melanoma are rare with high mortality rate and account for less than 1% of metastatic melanomas. Treatment options are limited with highest overall survival reported in those with complete surgical resection. Of cases reported in the literature with nonsurgical management, highest length of survival was reported to be 10 months. We report a case of malignant melanoma with isolated pancreatic metastasis treated with interferon therapy and immunotherapy, with evidence of progressive tumor shrinkage and survival at 38 months.
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