An Unusual Presentation of Leptospirosis: A Case of Septic Shock and Proteinuria.

Leptospirosis is a global health concern, particularly in tropical regions, with clinical symptoms varying from mild fever to severe organ dysfunction. We present a case of a 57-year-old male with septic shock and acute kidney injury due to acute leptospirosis. The patient's rapid progression to shock within a day of generalized symptoms was unusual.

Socioeconomic and Demographic Determinants of Readmission Rates in Congestive Heart Failure Patients: Insights From the Nationwide Readmissions Database.

Background Congestive heart failure (CHF) is a leading cause of hospitalizations and readmissions, placing a significant burden on the healthcare system. Identifying factors associated with readmission risk is crucial for developing targeted interventions and improving patient outcomes. This study aimed to investigate the impact of socioeconomic and demographic factors on 30-day and 90-day readmission rates in patients primarily admitted for CHF.

Successful Management of Atypical Hemolytic-Uremic Syndrome in Pregnancy Using Eculizumab: A Case Review.

Hemolytic-uremic syndrome (HUS) is a rare thrombotic microangiopathy characterized by the triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury. The disease is pathologically marked by fibrinoid necrosis within renal arterioles and glomerular capillaries. HUS can be categorized into typical variants, often linked to Shiga toxin-producing (STEC) infection, and atypical variants that stem from dysregulation in the alternative complement pathway.

Uncommon Manifestation: Thrombotic Thrombocytopenic Purpura Presenting Solely as Petechial Rash.

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder typically presenting with a classic pentad of symptoms: thrombocytopenia, microangiopathic hemolytic anemia, neurological abnormalities, renal dysfunction, and fever. This report explores an unusual presentation of TTP in a 47-year-old female with a medical history of hypertension, hyperlipidemia, and chronic TTP, who exhibited only petechial rashes, generalized weakness, and headache. Notably, the petechial rash, a less common manifestation of TTP, became a pivotal clue for the diagnosis, underscoring the necessity for vigilance even when classic symptoms are absent.

Extended-Spectrum Beta-Lactamase Escherichia coli-Associated Acute Cholangitis: Uncommon Patient Characteristics and Clinical Implications.

Acute cholangitis is a potentially life-threatening condition caused by an infection of the biliary tract resulting from biliary obstruction. This case report highlights an unusual presentation of acute cholangitis in an elderly patient characterized by the presence of extended-spectrum beta-lactamase-producing We aim to emphasize the significance of recognizing diverse clinical manifestations in the elderly population to enhance timely diagnosis and appropriate management. The case highlights the importance of better understanding patient risk factors for potential causative organisms and their susceptibility to selecting proper antibiotics and improving clinical outcomes.

Cement-Induced Chemical Burn in a Middle-Aged Male: A Case Report and Review of Literature.

This case study reviews a 48-year-old Hispanic male working in construction who presented with left upper medial thigh pain, redness, and swelling after exposure to hazardous chemicals during cement processing. Initially diagnosed with cellulitis and adjacent myositis, the patient met sepsis criteria and received empiric antibiotics. However, negative cultures and an evolving wound appearance shifted the diagnosis towards bullous diseases and chemical injury.

Glass in the Airways: A Bronchoscopic Challenge.

Foreign body aspiration (FBA) in adults is indeed a significant medical concern, albeit less common than in children. The increase in incidence with advancing age can be attributed to factors such as a decline in mental status and impairment of the swallowing reflex, which is more prevalent in the elderly population. The symptoms of FBA are highly variable, ranging from severe, acute asphyxiation, which may or may not involve complete airway obstruction, to more subtle signs like coughing, shortness of breath (dyspnea), choking, or fever.

Unusual Aspergillus Pleural Effusion in a Patient With Immunodeficiency.

Pleural aspergillosis is a rare form of invasive bronchopulmonary aspergillosis that is most often seen in immunocompromised hosts. It appears because of the coagulative necrosis of lung tissue induced by the species, which promotes the formation of a fungal pleural effusion. We present the case of a 51-year-old liver transplant patient on chronic immunosuppression therapy who presented with respiratory failure and was found to have a large left-sided pleural effusion from invasive aspergillosis.

Metastatic Prostate Cancer With Reticular Micronodular Opacities of Lung: A Case Report.

Prostate cancer, a common malignancy in males, can metastasize to various sites such as the bone, brain, liver, and less commonly, the lung. Detecting pulmonary metastases presents both diagnostic and therapeutic difficulties. Identifying patients with this condition is crucial for gaining a deeper comprehension of the disease's pathogenesis.

Rare Cause of Acute Loss of Vision in a Patient With Sickle Cell Trait.

Sickle cell disease (SCD) is a prevalent inherited blood disorder with various ocular manifestations, including sickle cell retinopathy (SCR), characterized by retinal microcirculation impairment and ischemic complications. We present the case of a 21-year-old male with sickle cell trait who experienced a sudden, painless loss of vision in his left eye. Ophthalmologic examination revealed vitreous hemorrhage and neovascularization, indicating SCR.

IgG4 Autoimmune Disease Masquerading As Oroantral Fistula.

IgG4-related disease (IgG4-RD) is an immune-mediated disorder that involves multiple organs and is characterized by the infiltration of lymphoplasmacytic cells, including IgG4-positive plasma cells, along with storiform fibrosis and obliterative phlebitis in the inflamed organs. The primary sites affected by this condition include the pancreas, bile ducts, salivary glands, aorta, lungs, kidneys, meninges, lacrimal glands, mediastinal lymph nodes, and retroperitoneum. The pathogenesis is linked to a type 2 T-helper-cell cytokine profile and the involvement of regulatory T cells.

Liquefied Lung Cancer: An Uncommon Form of Squamous Cell Carcinoma of the Lung.

Lung cancer is a significant global health concern, with high incidence and mortality rates. This case report presents the atypical presentation of a 71-year-old female with a history of lung cancer who initially presented with symptoms suggestive of infection secondary to a liquefied lung malignancy and later developed bronchial obstruction. Diagnosis of lung cancer requires a high level of clinical suspicion, and imaging techniques, such as PET and CT scans, provide additional evidence.

An Atypical Presentation of Chronic Inflammatory Myelin Degeneration in Neuromyelitis Optica (NMO).

Neuromyelitis optica (NMO) is an autoimmune disorder characterized by aquaporin-4 (AQP4) IgG autoantibodies. These autoantibodies induce chronic neuroinflammatory damage to the spinal cord and optic nerve. NMO clinically manifests as relapsing and overlapping neurodegenerative episodes of optic neuritis (ON) and transverse myelitis (TM).

Hemophagocytic Lymphohistiocytosis and Hodgkin Lymphoma in a Newly Diagnosed HIV Patient: A Diagnostic Dilemma.

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome that arises due to a dysregulated immune response caused by the aberrant activation of lymphocytes and macrophages. In this rare case report, we describe a newly diagnosed human immunodeficiency virus (HIV) patient who was found to have Epstein-Barr virus (EBV) provoked HLH and co-existing Hodgkin lymphoma (HL).  Our patient was a 28-year-old newly diagnosed HIV patient who presented with nonspecific symptoms, including bilateral foot pain and tingling sensation.

Dieulafoy's Lesion of the Duodenum: A Rare and Fatal Cause of Gastrointestinal Bleed.

Dieulafoy's lesion (DL) is an unusual cause of recurrent gastrointestinal bleeding that can be fatal. It can occur in various parts of the gastrointestinal (GI) tract, most commonly located in the stomach, especially at the level of lesser curvature; however, it can occur in other parts, including the colon, esophagus, and duodenum. A duodenal Dieulafoy lesion is characterized by the presence of a larger-caliber artery that protrudes through the GI mucosa and can lead to massive hemorrhage.

A 35-Year-Old Female With a Lupus Flare Presenting as Cardiac Tamponade: A Case Report.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple organ systems, significantly impacting the cardiovascular system. One potential complication of acute SLE flare is the development of pericardial effusion which can lead to potentially life-threatening consequences if not promptly identified. In this report, we describe the case of a 35-year-old female with a known history of SLE who developed rapid-onset, large-volume pericardial effusion with tamponade during a lupus flare.

COVID-19-Induced Myopathy and Diaphragmatic Weakness: A Case Report.

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that can induce myopathy, which can evolve into potentially life-threatening muscle weakness, including diaphragmatic paralysis. We present a case report of a 57-year-old female treated in the medical ICU for acute respiratory distress syndrome (ARDS) triggered by active COVID-19 infection, who subsequently developed worsening respiratory weakness from underlying COVID-19 myopathy manifesting as respiratory muscle weakness. Our patient's muscle biopsy highlights the development of muscle atrophy without evidence of inflammatory myopathy, making the presence of pre-existing autoimmune myopathy unlikely.

Clinical Conundrum of Acute Hepatitis B With Concurrent Hepatitis E Infection Leading to Severe Acute Liver Injury.

Acute liver injury in the setting of acute fulminant hepatitis caused by the hepatitis B virus (HBV) can occur both during primary infection and after chronic HBV reactivation. Guidelines recommend considering antiviral therapy in both cases. Antiviral therapy with a nucleoside analog may be beneficial in patients with acute liver failure from acute HBV infection, though not all studies have shown a benefit.

Nail Polish Remover Induced Methemoglobinemia: An Uncommon Occurrence.

Methemoglobinemia, defined as hemoglobin's impaired oxygen-carrying capacity due to oxidation from the ferrous (Fe2+) state to the ferric (Fe3+) state, has many well-documented etiologies. One example of an uncommon cause of acquired methemoglobinemia is the ingestion of nail polish remover, which can contain methemoglobin generators such as nitroethane, N,N-dimethyl-p-toluidine, and isobutyl nitrite. We present a case of methemoglobinemia in an 81-year-old male following accidental ingestion of isobutyl nitrite-containing nail polish remover, commonly used as a recreational inhalant.

Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy (CADASIL): A Rare Cause of Transient Ischemic Attack.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is increasingly recognized as an inherited and autosomal dominant arteriopathy of the cerebral vasculature, which is commonly misdiagnosed due to its different modes of presentation. It is characterized by variable manifestations of ischemic episodes, migraine with aura, cognitive deficits, and psychiatric disturbances. CADASIL is caused by a genetic mutation in the  gene, which is present on chromosome 19.

A Rare Case of Reverse Takotsubo Cardiomyopathy in a 28-Year-Old Female in Peripartum Period.

Reverse Takotsubo cardiomyopathy is a rare variant of Takotsubo cardiomyopathy in which ballooning occurs at the base of the heart rather than the apex, which is hyperkinetic. Takotsubo cardiomyopathy is usually considered in postmenopausal women, but a growing number of cases of the reverse variant are emerging in peripartum women. We present a case of peripartum reverse Takotsubo cardiomyopathy in a 23-year-old G1P0 female at 38 weeks gestation, induced by preeclampsia with severe features.

A Case of Malignant Pleural Effusion Secondary to Endometrial Cancer After One Year of Hysterectomy.

Endometrial cancer is the most common malignant tumor of the female genital tract. It can rarely metastasize to the lung, presenting as a pulmonary nodule and pleural effusion. Here we present a case of a 76-year-old female with a history of endometrial cancer who underwent a total abdominal hysterectomy and came one year later for evaluation of shortness of breath.

A Case of Severe Ovarian Hyperstimulation Syndrome Causing Pleural Effusion.

Ovarian hyperstimulation syndrome is one of the complications of treating infertility by ovarian stimulation. As a result of the stimulation, there is a shift of serum from the intravascular space to the third space, leading to complications like ascites and pleural effusion. Here we present a case of a 29-year-old female with polycystic ovarian syndrome who was being treated for infertility using ovarian stimulation agents for in-vitro fertilization.