Gout is a rare phenomenon in reproductive age women due to the uricosuric effects of estrogen. Furthermore, gout in pregnancy has been reported in only a scant number of case reports. We present the case of a 21-year-old gravida-4 para-3 female at four-weeks gestation presenting with acute polyarticular gout, complicated by Haemophilus influenzae sepsis and hyperemesis gravidarum. The gout flare was likely precipitated by primary H. influenzae bacteremia, which was successfully treated with intravenous antibiotics. The treatment of gout in pregnancy is challenging because of the limited number of guidelines. We demonstrate successful management of an acute gout flare in pregnancy with colchicine and steroid injection of the affected joint. Unfortunately, the patient suffered a miscarriage, but the link between gout flare and spontaneous abortion is tenuous.
Monoamniotic twin pregnancies are exceedingly rare. These are high-risk pregnancies that present a unique set of challenges for the obstetrician-gynecologist. There is a high risk of intrauterine fetal demise, secondary to co-morbid conditions including, but not limited to, congenital anomalies and umbilical cord entanglement. Successful delivery and favorable neonatal outcomes are predicated on early diagnosis, intensive fetal monitoring, and timely delivery. The management guidelines for these pregnancies rely primarily on retrospective studies and expert consensus, although some substantial conclusions can be made regarding appropriate antepartum and intrapartum care. We present the case of a 38-year-old gravida four, para three, with monoamniotic twins who delivered successfully after inpatient hospitalization at viability, administration of corticosteroids for fetal lung maturity, and vigilant fetal monitoring. We conclude that the combination of early ultrasound, intensive fetal monitoring, and interdisciplinary coordination among generalist obstetrician-gynecologists, maternal-fetal medicine specialists, and nursing staff is paramount for providing the greatest chance of a favorable outcome.
Benign multicystic peritoneal mesothelioma (BMPM) is a rare neoplasm of the abdominal mesothelium (i.e., peritoneum, mesentery, and omentum). We present the case of a 74-year-old male who presented with a right paracolic gutter fluid collection and cystic mass. The patient underwent diagnostic laparoscopy with resection of the mass. The final pathology revealed BMPM. The pathogenesis may have been related to longstanding diverticular disease, which could prove to be an underrecognized risk factor for the development of BMPM. Therefore, this case suggests a broadened differential diagnosis to include BMPM in specific cases of pre-operatively diagnosed colonic masses. The patient is disease-free 11 months postoperatively.
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