To our knowledge and literature search, Staphylococcus schleiferi subspecies coagulans infection in human beings has rarely been described in the medical literature. Furthermore, we believe that this is a first detailed case report of methicillin-resistant Staphylococcus schleiferi subspecies coagulans infection in a patient with hepatocellular carcinoma. Because of the possible association of Staphylococcus schleiferi infection and immunosuppression, any isolates of this bacterium in human beings should be presumed to be pathogenic, unless proven otherwise.

Brugada syndrome is an inherited arrhythmogenic disease, characterised by a coved-type ST segment elevation in right precordial leads and an increased risk of sudden cardiac death due to ventricular arrhythmia. To unmask or exacerbate a Brugada ECG pattern, class IA or IC antiarrhythmic agents are used, and clinicians can predict sudden cardiac death in a high-risk patient. However, phenytoin, one of the class IB agents, may induce a Brugada pattern ECG at a supra-therapeutic level and this association has rarely been reported. We describe a case of a patient with a phenytoin level about twice as high as the therapeutic level, which led to the emergence of a type 1 Brugada pattern ECG. Awareness should be made between this important association of supra-therapeutic phenytoin level and type 1 Brugada pattern ECG because symptomatic Brugada syndrome can lead to sudden cardiac death.

Coved-type ST-segment elevation in the right precordial leads are the characteristics of Brugada syndrome, an inherited arrhythmogenic ion channel disease, which could lead to ventricular arrhythmia and sudden death. Hypokalemia alone may induce Type 1 Brugada pattern electrocardiogram (EKG), and the association has rarely been reported. We describe a patient with hypokalemia 2.9 mmol/L and the appearance of new right bundle branch block pattern with coved ST-segment elevations with inverted T wave in leads V1-V2. Serum potassium was corrected and repeated EKG 6 h later revealed disappearance of Type 1 Brugada pattern. Although there is no definite value of serum potassium level that can induce Brugada pattern EKG, hypokalemia may unmask Type 1 Brugada EKG pattern. Awareness of its appearance should be made by all physicians since patients with a family history of arrhythmia or sudden cardiac death (SCD) are at the high risk of developing SCD.

Giant cell arteritis (GCA) presenting solely as fever is very rare. Usually, it manifests with typical features such as visual problems, headache, jaw claudication, or it can be associated with polymyalgia rheumatica. We present a case of a patient with GCA who presented only with prolonged fever. The cause of fever could not be initially identified in spite of a comprehensive workup. The patient was started on steroids for presumed GCA resulting in the resolution of fever. It is of paramount importance to consider GCA in the differential diagnosis of fever of unknown origin. Early diagnosis with effective treatment is crucial since the mortality rate remains high for untreated cases.

Malignant melanoma is generally chemo- and radio-resistant, and patients with advanced melanoma have a poor prognosis. However, with our increased understanding of the checkpoint immune molecules and genetic alterations of melanoma cells, more effective immunotherapy, such as anti CTLA4 antibody and anti PD-1 antibodies, and targeted drug therapy, such as BRAF inhibitors and MEK inhibitors, have been developed, resulting in improved overall survival and quality of life of patients with advanced melanoma. In addition, emerging technologies to develop prognostic and predictive biomarkers for response to systemic therapy could help clinicians make more accurate assessments of the disease and formulate more effective treatment plans. In this review, current standard systemic therapy options and recently developed novel drugs for advanced melanoma are discussed.

Our search of literature revealed combined elevations of serum cancer antigen 125 levels and rheumatoid factor levels in a patient with peritoneal tuberculosis has rarely been reported. Thus, we describe the case of a 63-year-old female with large abdominal ascites and malignancy was ruled out with biopsy. High levels of serum cancer antigen and rheumatoid factor were noted. Physicians should be aware that tuberculosis infection could induce elevation of rheumatoid factor levels in the absence of rheumatologic symptoms or disease. A high index of suspicion is required because peritoneal tuberculosis is a great mimicker of other abdominal pathology, especially intraabdominal malignancies and can mislead physicians to undergo unnecessary interventions.

Macrophage activation syndrome (MAS) itself is a rare, potentially life-threatening complication of a rheumatic disease, mostly seen in juvenile idiopathic arthritis. It infrequently occurs in systemic lupus erythematosus (SLE), and it is extremely rare to be the first presentation of SLE. In a study of 511 patients with SLE, 7 cases (1.4%) of MAS were identified. In all the cases, MAS was simultaneous to the presentation of SLE in this article, we report a case of a patient with MAS who presented with fever, rash, and high ferritin level up to 16911 ng/mL. A high degree of suspicion is required that high fever and rash can be clues to MAS. Early diagnosis is necessary since mortality rates remain high for untreated cases.

Our search of the literature revealed no detailed case reports about drug fever induced by piperacillin/tazobactam in a patient with HIV infection although there were a few case reports about drug fever due to piperacillin/tazobactam with other comorbidities. A 63-year-old male patient with HIV positive was admitted for acute cholecystitis. He was started on piperacillin/tazobactam. For the next 8 days, he had intermittent fever up to 103°F (39.4°C) with relative bradycardia although he showed clinical improvement. There was no laboratory or imaging findings suggestive of another infectious source and drug fever was suspected. The antibiotics were stopped and after 48 hours no fever was observed until the day of discharge. Piperacillin/tazobactam can induce fever in patients with cystic fibrosis and in patients with other conditions. Drug fever may be more prevalent in patients with HIV infection. It has no characteristic pattern and may not be associated with eosinophilia.