Gastrointestinal stromal tumors (GISTs), even though rare, remain the most common mesenchymal tumors of the gastrointestinal (GI) tract. When GISTs occur outside of the GI tract, they are termed extragastrointestinal stromal tumors (EGISTs). Most GISTs arise from the stomach (50-70%) and small intestine (20-30%). A smaller percentage of these tumors also occurs in the large intestine (5%) and esophagus (2-5%). EGISTs have histopathological and molecular characteristics that are similar to GISTs. However, the precise incidence and tumor behavior of EGISTs are not fully understood. EGISTs have no specific symptoms or radiologic features, and in most cases, the presenting complaint is abdominal pain or discomfort. Yet, they tend to be more aggressive and have a worse prognosis than GISTs. Morphologic diagnosis based on microscopic examination of histological sections is the standard diagnostic procedure for GIST/EGIST. In this patient-centered study, we present a case of EGIST that originated in the anterior perirectal space, an extremely rare location; we also describe the endoscopic approach that was used to biopsy the tumor.
Buried bumper syndrome (BBS) is a rare but severe complication of percutaneous endoscopic gastrostomy (PEG) tube feeding. Patients with BBS lose PEG tube patency and may experience peristomal pain, content leaks, or peritonitis. An early diagnosis can avert further complications. BBS is a clinical diagnosis, but an abdominal computerized tomography scan or upper endoscopy is needed to confirm the diagnosis. BBS is a long-term complication of PEG tube feeding, and cases of acute onset are scant in the literature. We report a unique case of a 65-year-old female with a history of stroke who developed BBS five weeks after PEG tube placement.
Post-influenza myositis is considered a distinct clinical entity and is associated with muscle pain and elevated muscle enzymes during convalescence. Although the exact mechanism of muscle injury in acute viral myositis is unknown, there are possible mechanisms proposed in the literature. The progression of viral myositis to rhabdomyolysis, although uncommon, can be life-threatening and has been reported with many viruses, most commonly influenza. At our institution, a case of severe influenza-induced myositis prompted us to conduct a literature search focusing on the incidence, pathophysiology, typical presentation, and proper diagnosis of this rare condition.
We present a unique case of Weil's disease, a severe form of leptospirosis caused by Leptospira interrogans, a rare agent seen in both temperate and tropical climates but is more commonly seen in tropical climates and transmitted to humans commonly by rodent urine contamination. It is an under-reported infection, with 1.03 million cases documented annually, and is not commonly found in the United States. A 32-year-old African American male presented with abdominal pain and pressure in his chest associated with nausea, vomiting, and diarrhea. On exam, scleral icterus, sublingual jaundice, and hepatosplenomegaly were noted. Imaging studies revealed the patient had incidental situs inversus and dextrocardia. Labs revealed leukocytosis, thrombocytopenia, transaminitis, and significant direct hyperbilirubinemia of over 30 mg/dL. An extensive workup revealed the patient had leptospirosis due to rat contamination in his apartment. The patient was treated with doxycycline, and his clinical status improved. The heterogeneous and unique clinical presentation of leptospirosis gives rise to a broad differential diagnosis. We aim to encourage physicians who encounter similar presentations in similar urban settings in the United States to include leptospirosis in their differential.
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