Idiopathic inflammatory myopathies (IIMs) are a group of chronic autoimmune disorders characterized by proximal skeletal muscle weakness. One subtype of the IIMs is immune-mediated necrotizing myopathy (IMNM). IMNM can be further classified according to its autoantibody presence, including anti-3-hydroxy-3methylglutaryl-coenzyme A reductase (HMGCR), anti-signal recognition particle (SRP), and seronegative.Here, we describe the case of a 61-year-old Caucasian female with a prior history of distant lung cancer and current statin use presenting with a subacute onset of bilateral proximal lower extremity muscle weakness and markedly elevated creatinine kinase (CK) and amino transaminases. In the acute inpatient setting, she underwent successful treatment with corticosteroids that were eventually discontinued and replaced with azathioprine three months after hospital admission. At that point, she had attained a 60% increase in muscle strength.

The association between gastrointestinal stromal tumor (GIST) and neurofibromatosis type 1 (NF1) has been documented in medical literature but remains rare. We report a 53-year-old male patient who was investigated extensively for months for lower gastrointestinal tract (GIT) bleeding that remained obscure despite upper and lower endoscopies as well as a barium follow-through. His past medical history is significant for NF1 with numerous cutaneous neurofibromas as well as café au lait spots and bilateral functional pheochromocytoma status post-bilateral adrenalectomy. However, the progression of his bleeding as well as iron deficiency anemia prompted more aggressive investigations. These have revealed a small bowel mass that proved to be GIST on histological and immunohistochemical staining examination. This case helps remind clinicians of the important association between NF1 and GIST, and the clinical pearl that most GISTs in NF1 are located in the small intestine and may not be apparent on endoscopy with barium follow-through and require push enteroscopy to allow for better localization.

Cefepime is a commonly used antibiotic. However, cefepime-induced neurotoxicity (CIN) is less commonly recognized. We describe a 75-year-old female on sertraline and risperidone who has been on cefepime for 28 days for treatment of osteomyelitis and presented with mutism, generalized rigidity, hyperreflexia, generalized stimulus-induced myoclonus, and reactive dilated pupils and found to have developed acute kidney injury. Although the diagnosis of serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) was suggested initially, the clinical picture was more compatible with CIN. Hemodialysis was suggested but gradual improvement in renal function allowed for gradual neurological recovery. This case highlights the importance of considering CIN in those who have been on Cefepime and present with altered mental status, especially in the appropriate clinical context and presence of risk factors. The overlap in clinical presentation between CIN, SS, NMS, and Catalonia may lead to a diagnostic challenge. Myoclonus seems to be characteristic of CIN and serves as a good clue to hint toward the diagnosis. This case helps to display the similarities and differences in the clinical presentation of these entities and therefore helps avoid confusion and prevents unnecessary therapeutic interventions.

As the use of COVID-19 vaccines gains more prevalence, rare and uncommon side effects are reported in the medical literature. This is a case report of a 75-year-old male patient who presented on the second day after receiving the Moderna Bivalent mRNA COVID-19 booster vaccine with abrupt onset behavioral changes and global aphasia with no focal deficits. Stroke and infectious meningitis/encephalitis were ruled out. Signs of aseptic inflammation were seen on cerebrospinal fluid (CSF) analysis. Workup for autoimmune and paraneoplastic encephalitis was unyielding. The observation of rapid clinical improvement prompted watchful waiting that concluded in the resolution of clinical manifestations within less than a week of onset. This case is reported to support the currently limited knowledge of rare neurological sequelae of mRNA vaccine and is in line with recently published few cases that suggest vaccine-related encephalitis.

Cocaine abuse has an overwhelming effect on the healthcare system due to its multiple complications. Cardiovascular complications carry the highest burden. Common cardiovascular manifestations of cocaine are related to its adrenergic effects due to the inhibition of dopamine and norepinephrine uptake at the postsynaptic terminal. However, chronic abuse can lead to desensitization of adrenergic receptors, which can lead to bradycardia. Sinus bradycardia can be one of the markers of chronic cocaine abuse, as exemplified in this case report. Therefore clinicians should be aware of this association.