Acute gastric volvulus is a rare yet life‐threatening condition with mortality ranging from 30% to 50% if not treated promptly. The stomach rotates on itself causing strangulation precipitating necrosis, cameron lesions, and perforation. Long‐standing paraesophageal hernia is a common cause of organoaxial gastric volvulus.
The alkaloid derivatives of Mitragyna speciosa, commonly known as kratom, pose a threat to society due to its potential for abuse, adverse reactions and tendency to be used as self-medication for opioid withdrawal, pain and mood disorders. A number of deaths have been reported along with complications such as respiratory depression, cardiopulmonary arrest, torsade de pointes and seizures. Its various effects and potential are yet to be fully studied. We describe the case of a healthy young male who presented with progressive respiratory failure requiring mechanical ventilation. Imaging revealed multifocal lung infiltrates while extensive infectious and cardiac work-up was negative. Based on the clinical course, a diagnosis of acute respiratory distress syndrome (ARDS) caused by kratom was made. The patient showed gradual clinical improvement and was weaned off supplemental oxygen. This case highlights yet another adverse reaction to kratom and the growing threat posed by its use.
A 49-years-old female presented with severe persistent headache. Further evaluation unraveled fungating right breast mass and a new diagnosis of poorly differentiated invasive ductal carcinoma with brain metastasis as the cause of the symptoms was made. Diagnosis of breast cancer with large fungating mass and brain metastasis on presentation in this era is still shocking. It makes us question the reasons behind these unfortunate presentations which include but are not limited to: unawareness about the risk factors, symptoms, complications and the available screening guidelines, embarrassment from the site of lesion, or socioeconomic status.
Key Clinical MessageDiscussion about breast cancer and screening mammogram at 40-49 years will create awareness about it and encourage females volunteer any abnormalities. Breast examination at every annual physical visit should be encouraged among physicians.
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