We present the case of a 28-year-old female who presented for primary care at 22-week gestation with type II achalasia and worsening solid/liquid dysphagia leading to pregnancy weight loss. Considering that durable therapies such as surgical myotomy and pneumatic dilatation have considerable risk, botulinum A toxin injection was selected as a temporizing bridging therapy. She had an uncomplicated post procedure course and had significant rapid improvement in dysphagia symptoms, which enabled her to progress to normal peripartum weight. This case highlights the need for early recognition of achalasia and an unique niche for use of botulinum toxin A as a temporizing therapy in this risk averse population.
Breast cancer is the leading cause of female malignancy-associated death worldwide. The most common sites of metastases are the lung, liver, brain, and skeleton. A 68-year-old female with invasive lobular carcinoma metastatic to the axial skeleton was found to have new skin and colonic metastases discovered on serial surveillance positron emission tomography-computed tomography scans. The colonic metastases did not present with any gastrointestinal symptoms and did not form exophytic masses, which are typically associated. Instead, her colonic metastases presented as unusual diaphragm-like strictures within the left colon discovered on endoscopy, which is a relatively rare phenomenon. This case raises awareness of and elucidates new manners of presentation of metastatic invasive lobular carcinoma within the colon.
A 27-year-old Caucasian man was transferred from a remote clinic with acute kidney injury for the prior 7–10 days preceded by gastroenteritis. His kidney biopsy showed non-specific mesangiopathic glomerular changes, minimal tubulointerstitial disease without sclerosis, crescents, nor evidence of vasculitis. On his third hospital day, he developed acute hypoxic respiratory failure requiring intubation and mechanical ventilation. Pulmonary renal syndromes ranked highest on his differential diagnosis. He was extubated after 2 days of mechanical ventilation and after pulse dose steroids. His lung biopsy showed pulmonary capillaritis. Our case describes a patient with clinically appearing renopulmonary syndrome, but found to have pulmonary capillaritis, a rare form of lung disease that may also cause acute kidney injury.
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