Severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2) is the novel coronavirus initially detected in Wuhan, China, and is responsible for the worldwide pandemic coronavirus disease 2019 (Covid-19). Influenza is a common endemic respiratory virus that causes seasonal outbreaks of respiratory illness. There are currently few reports in the literature describing patients with coexisting infections. This case series of 4 patients identified at our single institution in Louisiana highlights the patient characteristics, laboratory findings, and outcomes in patients with both Covid-19 and influenza infection.
Anti-glomerular basement membrane disease (anti-GBM) is a well-documented, small vessel vasculitis that is classically associated with glomerulonephritis and alveolitis [
1
]. However, regardless of clinical process, not every patient will present with a constellation of classically associated symptoms. Literature review demonstrates that early anti-GBM disease can present as glomerulonephritis without alveolitis [
2
,
3
]. In this case report, we describe the unique clinical course of a 26-year-old male who originally presented with hemoptysis and his subsequent clinical workup revealing anti-glomerular basement membrane disease without renal involvement.
Splenic injury after endoscopic retrograde cholangiopancreatography (ERCP) has been documented in less than 30 cases. Here, we present a case that involves a 52-year-old male with choledocholithiasis who developed a splenic injury and major hemorrhage immediately after ERCP. The patient ultimately required splenic artery embolization without splenectomy, a novel treatment approach. The case demonstrates the importance of having a high index of suspicion of this rare complication as well as discusses potential causes of post-ERCP splenic injury and a treatment approach that does not involve splenectomy.
infiltrate with t(11;14)(q13;q32) on FISH analysis and the patient was diagnosed with MCL. Patient's symptoms resolved and given the asymptomatic and localized nature with isolated gastrointestinal extranodal disease he is monitored with serial imaging. Discussion: Primary gastrointestinal MCL is a rare disease with a variety of clinical presentations. The diagnosis can be challenging as patients who are symptomatic present with vague reports of anorexia, bloating or abdominal pain. Radiographically the lymphoma may or may not be apparent. Endoscopically the MCL can range from normal appearing mucosa to polypoid or ulcerated lesions. In this patient, it is likely that the ileal lesion periodically prolapsed into the colon-explaining the imaging findings. In the initial colonoscopy, the prolapsed segment spontaneously reduced, leaving only the falsely reassuring normal colon. High clinical suspicion based on subsequent imaging led to repeat colonoscopy with ileal intubation and tissue sampling, yielding the diagnosis.
Discussion: Villous adenomas, normally a benign condition, can present with a life-threatening electrolyte derangements and volume depletion which makes the ability to diagnose and adequately treat MWS critical. Patients typically have multiple admissions with watery or mucous diarrhea, nausea, and vomiting. Labs significant for hyponatremia, hypokalemia, AKI, and leukocytosis. The tumors are large and often past the splenic flexure and low in the rectum, therefore flexible sigmoidoscopy can be reliably used rather than colonoscopy, which often delays diagnosis due to patients' inability to prep. Treatment includes aggressive fluid and electrolyte repletion until tumor can be surgically resected. Few case reports suggest using indomethacin or octreotide as a bridge to surgery or as medical management for patients who are not surgical candidates. However, patients who are managed medically have a mortality rate up to ;61-100%. Surgical management to definitively resolve symptoms, although minimally invasive options are being explored. A high index of suspicion and a systematic approach is critical to diagnose and provide life-saving treatment for MWS patients.Tumor biopsy demonstrating positive to immunohistochemical stain for SOX-10, a common marker for malignant melanoma. C) Tumor biopsy with immunohistochemical stain for Melan-A positivity.
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