Background: IgA vasculitis is the most common form of systemic vasculitis in children but can occur in adults. Inciting antigens include infections, drugs, foods, insect bites, and immunizations. Antibiotics and tumor necrosis factor (TNF) alpha inhibitors are the most common class of drugs that cause IgA vasculitis. Although sotalol and rivaroxaban have been documented to cause leukocytoclastic vasculitis, we have never come across any literature attributing IgA vasculitis to either drug. Additionally, Rocky Mountain spotted fever has not been associated with IgA vasculitis despite being described in cutaneous and systemic vasculitis cases. Here we present a case of IgA vasculitis triggered by sotalol with challenging differentials including recent infection with Rocky Mountain spotted fever, malignancy, and rivaroxaban as possible triggers. Case Presentation: 68 yr old male with history of lung cancer treated with resection and chemotherapy 5 years ago currently in remission, and recently was started on sotalol and rivaroxaban for new-onset paroxysmal atrial fibrillation. He presented with diffuse petechial/purpural rash on the lower limbs, multiple joint pain, severe abdominal pain and rectal bleeds, hemoptysis, and renal dysfunction. IgG titers for RMSF were high. Punch biopsy of skin and renal biopsy consistent with IgA vasculitis. Sotalol and rivaroxaban was stopped. patient was treated with oral prednisone and improved. Conclusion: Ig A vasculitis is mostly a self-limiting disease, but adults tend to have severe course. It is important to diagnose early and identify a trigger. Removing offending agent or treating underlying infection is an important aspect of management.
Esophageal candidiasis (EC) is a common opportunistic infection in patients with impaired cellular immunity, such as human immunodeficiency virus (HIV) infection. However, it can also be found in individuals with certain predisposing conditions like uncontrolled diabetes mellitus (DM) and the use of certain medications. We report a 54-year-old female with past medical history of DM, hypertension and hyperlipidemia who presented to the ER with worsening periumbilical and epigastric pain for 2 days. She had multiple similar presentations requiring admissions to different hospitals and had undergone extensive workup over the past year. She only had transient improvement from these hospitalizations. Esophagogastroduodenoscopy (EGD) performed on day 2 of admission revealed extensive creamy pseudomembranous exudate through the entire length of esophagus confirmed as Candida albicans by brush scraping analysis. She received oral fluconazole with significant relief of her symptoms over the next couple of weeks. Although EC remains asymptomatic in the majority of patients and is only detected incidentally on EGD, its diagnosis and treatment can provide significant symptomatic relief in many patients. EC should be considered as a potential diagnosis in the appropriate clinical setting even in patients with no evidence of overt immunodeficiency.
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