Besides an AIDS-defining illness, Kaposi sarcoma (KS) is also seen in individuals on long-term immunosuppressant therapy. We report KS in a 70-year-old immunocompetent man, which initially mimicked acute flare of ulcerative colitis (UC). He was hospitalized multiple times for complaints of watery diarrhea and tenesmus. Despite treatment with mesalamine, short courses of methylprednisolone, and one dose of infliximab, his symptoms improved only partially. He underwent colonoscopy, which revealed mild active colitis and a mass in the ascending colon. After treatment of acute flare with methylprednisone and mesalamine, he underwent total colectomy with end ileostomy. The histopathology confirmed stage I adenocarcinoma of colon. He continued to experience watery diarrhea, which was attributed to intractable UC, and he underwent protectomy several weeks later. The histopathology of rectum revealed KS. After surgery, watery diarrhea resolved completely. Review of literature suggests KS has been rarely reported in immunocompetent individuals with inflammatory bowel disease.
Cardiac perforation by a pacemaker lead is a rare complication of pacemaker implantation. Presentation can vary from chest pain and shortness of breath to the patient being completely asymptomatic. Diagnosis is usually made by high-resolution computed tomography (HRCT) scan of the chest. Electrocardiograph (EKG) usually shows the absence of a paced rhythm, but it doesn't provide a definitive diagnosis. We describe a case of late cardiac perforation by an atrial pacemaker lead with no signs or symptoms of pericardial tamponade.
With the rise of the number of states fully legalizing marijuana, the use of this substance in the United States is at an all-time high. This increasing legalization gives the impression that marijuana is rather safe. However, multiple reports by our groups and others documented serious cardiovascular complications associated with marijuana use ranging from life threatening arrhythmia to myocarditis and myocardial infarction. In this report, we present a case of a 61 year old man presented with left sided typical chest pain shortly after marijuana consumption with the diagnosis of non ST-elevation myocardial infarction (NSTEMI) established based on clinical, EKG and troponin values with eventual cardiac catheterization documenting non-occlusive coronary artery disease with 30% obstruction of the proximal first obtuse marginal artery. We also review the putative pathophysiologic mechanisms of marijuana induced coronary vasospasms, highlighting the implications of these findings in the evaluation and management of cardiac chest pain in marijuana users.
The sport of boxing carries with it the risk of brain injury with acute and chronic neurological injuries such has contusion, concussion and intracranial bleeding has been reported. The force sustained from a boxing blow can be as powerful as being hit with a 6-kg wooden mallet striking at 20 mph. Bilateral cerebellar hemorrhage secondary to trauma is a rare entity that has not been reported in the literature previously. One can only speculate as to how a boxer could potentially develop a cerebellar bleed. Regardless of whether a very powerful punch or the act of falling back and hitting the occipital region directly on the floor, it is very likely that a predisposing factor exist. We present you a rare case of a 26 year-old male boxer who was knocked out in a boxing match and was noted to have acute parenchymal and subarachnoid hemorrhage bilaterally in the cerebellar hemispheres. Our report highlights the need to consider cerebellar bleed in boxers who present after ataxia after boxing/knocked out.
Acalculous cholecystitis (AC) is an inflammation of the gallbladder in the absence of gallstones. There are many risk factors associated with AC. However, this report implicates allopurinol as an inciting agent for a severe systemic drug reaction, i.e., the drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome complicated by AC. We report a Chinese woman who presented on two occasions with a diffuse maculopapular rash, elevated liver enzymes, and upper abdominal pain attributable to acute AC, the second episode of which developed after the reintroduction of allopurinol treatment for gout. The AC complicated the DRESS syndrome during the course of her hospitalization.
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