Pylephlebitis is a rare and potentially fatal complication of many common abdominal pathologies. Here we describe an unusual case of pylephlebitis associated with ulcerative colitis. A 51-year-old male with a history of ulcerative colitis, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) presented for shortness of breath, fevers, chills, and generalized weakness. The patient was discharged one week prior to this admission after being treated for an acute colitis flare and adverse reaction to sulfasalazine. The current admission was significant for fever, leukocytosis, and lactic acidosis and a portal vein thrombus seen on computed tomography scan. The presentation of sepsis and portal thrombus were consistent with pylephlebitis and he was subsequently started on antibiotics and anticoagulated. He was discharged home and made a full recovery. Here we present a unique case of pylephlebitis associated with ulcerative colitis. Ultimately this case report serves as a good reminder to stay diligent and keep a broad differential diagnosis when treating a septic patient.
Choriocarcinoma is a germ cell tumor characterized by widespread metastases and poorly differentiated cells. Non-gestational choriocarcinoma, or primary choriocarcinoma is a trophoblastic disease which is associated with a poor patient prognosis and is markedly angioinvasive. Primary non-gestational mediastinal choriocarcinoma is a very rare disease and represents an aggressive malignancy, primarily seen in young males. Those with primary mediastinal choriocarcinoma have symptoms that are non-specific such as cough, dyspnea, hemoptysis, and chest pain. Here we present the case of a 47-year-old Caucasian female who presented with worsening dyspnea and cough. Laboratory testing revealed elevated alkaline phosphatase, human chorionic gonadotropin, and cancer antigen 125. Chest X-ray was significant for a large right pleural effusion and a computed tomography angiogram of the chest showed a soft tissue mass in the anterior medial right lung base/right middle lobe. Thoracentesis yielded results consistent with malignant cells favoring a germ cell tumor. Biopsy of the mediastinal mass revealed positivity for inhibin and both human chorionic gonadotropin and CD-10 which led to the diagnosis of primary choriocarcinoma. Primary mediastinal choriocarcinoma is uncommon and often has a non-specific clinical presentation. A high degree of suspicion is needed as this malignancy can be aggressive, necessitating urgent definitive tissue biopsy diagnosis to guide appropriate therapy.
Breast cancer relapse remains a common cause of morbidity and mortality in patients who initially underwent surgical treatment with or without chemotherapy and radiation. Rates of recurrence are highest in the first two years after diagnosis but the rate of relapse remains persistent more than a decade after diagnosis. Additionally, pleural metastasis of breast cancer, which often presents as a malignant pleural effusion, typically occurs during the first few years after diagnosis but is not common after a long period of disease-free survival. This is a case of breast cancer relapse after 7 years of disease-free survival with lung metastasis and malignant pleural effusion secondary to pleural metastasis and without locoregional recurrence.
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