Severe hyponatremia due to trimethoprim-sulfamethoxazole-induced SIADH.

Hyponatremia, a serum sodium level of <135 mEq/L, is the most common electrolyte abnormality occurring in 5%-35% of hospitalized patients. It is a predictor of increased morbidity and mortality. Diuretics, psychotropic, and antiepileptic drugs are commonly implicated in drug-induced hyponatremia.

Unusual presentation of a small cell lung cancer with bilateral breast metastases: Case report and a brief review of the literature.

Small cell lung cancer (SCLC) is a smoker's disease and occurs almost exclusively in smokers. SCLC is a high-grade neuroendocrine tumor and commonly presents as a central tumor with bulky mediastinal adenopathy. It is notorious for causing widespread disease and paraneoplastic syndromes.

Bronchoesophageal fistula: An unusual manifestation of lung cancer.

Bronchoesophageal fistula (BEF) is a rare condition caused by a fistulous connection between the bronchus and the esophagus. BEF can be acquired or congenital; congenital BEFs are rarely encountered in adults. Acquired BEF can be due to either a benign or a malignant process.

Upper airway hematoma: An unusual presentation of acute upper airway obstruction.

Acute upper airway obstruction secondary to supraglottic hematoma is a rare but life-threatening complication of oral anticoagulants, particularly with warfarin. Symptoms include sore throat, dysphagia, odynophagia, dysphonia, neck swelling, and dyspnea. We are reporting a case of an elderly male on warfarin therapy who developed acute upper airway obstruction due to spontaneous supraglottic hemorrhage.

Upper airway hematoma: An unusual presentation of acute upper airway obstruction.

Acute upper airway obstruction secondary to supraglottic hematoma is a rare but life-threatening complication of oral anticoagulants, particularly with warfarin. Symptoms include sore throat, dysphagia, odynophagia, dysphonia, neck swelling, and dyspnea. We are reporting a case of an elderly male on warfarin therapy who developed acute upper airway obstruction due to spontaneous supraglottic hemorrhage.

Acitretin induced lung injury by differentiation syndrome.

Differentiation syndrome is a life-threatening complication observed when retinoic acid is given to patients with acute promyelocytic leukemia. Retinoid compounds are also used in non-malignant conditions like psoriasis and it is rare to see differentiation syndrome in such settings. This reports details the clinical presentation and successful management of a patient with psoriasis who developed differentiation syndrome while on treatment with acitretin.

Organizing Pneumonia Associated with Pegylated Interferon α and Ribavirin Therapy.

Hepatitis C virus infection is the leading cause of chronic liver disease in the United States of America. Pegylated interferon α and ribavirin combination is the mainstay of treatment. Severe pulmonary toxicities are rarely reported.

Varicose vein trauma: a risk for pulmonary embolism.

Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak.

Giant adrenal myelolipoma masquerading as heart failure.

Adrenal myelolipomas are rare benign tumors of the adrenal cortex composed of adipose and hematopoietic cells. They have been postulated to arise from repeated stimulation by stress, inflammation and ACTH oversecretion. Myelolipomas are usually detected incidentally on imaging and do not require any active intervention besides regular follow-up by imaging.

Unusual synchronous lung tumors: mucoepidermoid carcinoma and mucinous adenocarcinoma.

Primary mucoepidermoid tumors of the lung are rare entities. Synchronous primary malignancies of the lung involving mucoepidermoid carcinoma and mucinous adenocarcinoma are even rarer and constitute a unique set of patient population. The presentation, diagnosis and treatment strategies for this patient population are not well described.

Dose adjustment of carboplatin in patients on peritoneal dialysis.

The Calvert equation has been extensively used to determine the dosage of carboplatin. However, in patients on dialysis, it predicts the same dosage regardless of the frequency of dialysis. Clearance of carboplatin during hemodialysis has been studied to a lesser extent, but there have been very few studies which have investigated the clearance of carboplatin in patients on peritoneal dialysis.

Dose adjustment of carboplatin in patients on hemodialysis.

Carboplatin is one of the most prescribed cytotoxic drug, which is extensively used in the treatment regimens of several malignancies. The therapeutic efficiency of carboplatin has been found to correlate the area under curve (AUC). The Calvert formula has been extensively used to determine the dose of carboplatin for a fixed AUC and glomerular filtration rate (GFR).

Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation.

Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention.

Renal medullary cancer in a patient with sickle cell trait.

Renal medullary cancer is a rare malignancy almost exclusively seen in young patients of African ethnicity. These patients often present with the cardinal symptoms of hematuria, flank pain, and an abdominal mass, and this malignancy has been associated with patients carrying sickle cell trait. It is estimated that 300 million people worldwide carry sickle cell trait, and the presence of hematuria in these patients should be treated as a harbinger of a possible malignancy.

Benign metastatic leiomyoma presenting as a hemothorax.

Uterine leiomyomas have been reported to metastasize to various organs including the lungs, skeletal muscles, bone marrow, peritoneum, and heart. They may present with symptoms related to the metastases several years after hysterectomy. These tumors regress after menopause, and it is rare to detect active tumors in postmenopausal women.

Ovarian hyperstimulation syndrome as an etiology of obstructive uropathy.

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of controlled ovarian hyperstimulation (COH) protocols performed in women undergoing assisted reproductive technologies. Overstimulation of the ovaries results in the overproduction of vasoactive cytokines and mediators by the ovaries, thereby causing a generalized capillary leak and acute shift of protein-rich fluid from the intravascular compartment into the third space. This may lead to the development of ascites, pleural effusions, pericardial effusion, anasarca, intravascular volume depletion, hemoconcentration, oliguria, hypoalbuminemia and hypoproteinemia, electrolyte imbalances, acute renal failure, abdominal compartment syndrome, thromboembolic events, and adult respiratory distress syndrome.

Identifying oncological emergencies.

Prompt identification and treatment of life-threatening oncological conditions is of utmost importance and should always be included in the differential diagnosis. Oncological emergencies can have a myriad of presentations ranging from mechanical obstruction due to tumor growth to metabolic conditions due to abnormal secretions from the tumor. Notably, hematologic and infectious conditions may complicate the presentation of oncological emergencies.

Diffuse alveolar hemorrhage due to ketorolac tromethamine.

Drug-induced lung disease (DILD) is a common but frequently missed diagnosis. Therefore, a high index of clinical suspicion and familiarity with the clinical syndromes associated with DILD are important in making the diagnosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the mostly commonly used classes of medications.

Uterine sarcoidosis: a rare extrapulmonary site of sarcoidosis.

Sarcoidosis is a multisystem disease which is most commonly manifested in the pulmonary system. However, extrapulmonary manifestations have also been frequently reported. Isolated occurrence of sarcoidosis in the genital system is rare and poses a diagnostic and therapeutic dilemma.

Solitary fibrous tumor of the pleura.

Solitary fibrous tumor of the pleura (SFTP) is a rare tumor of mesenchymal origin which can grow to a large size and present with symptoms of cough and pleuritic chest pain. No specific etiological factors for SFTPs are known and they may grow undetected for several years. These tumors are usually benign and may mimic a variety of malignancies.

Uterine leiomyosarcoma manifesting as a tricuspid valve mass.

Uterine leiomyosarcoma is a rare malignancy and carries a poorer prognosis when compared to endometrial carcinoma. It has been observed to metastasize to all the major organs. It presents with symptoms of abdominal distension, vaginal bleeding and may pass unnoticed until an advanced stage in patients with leiomyomas.

Extracavitary manifestation of primary effusion lymphoma as a right atrial mass.

Primary effusion lymphoma (PEL) is a subset of large B cell lymphomas and has been mostly associated with human immunodeficiency virus infection. Rare cases have been reported in organ transplant recipients and chronic hepatitis C patients. It typically presents as an effusion in the pleural and pericardial spaces but rarely disseminates.