Hepatosplenic sarcoidosis.

Sarcoidosis is a systemic disorder characterized by development of granulomas within various organs in the body. It commonly affects people of African American and Scandinavian heritage between the ages of 20 and 40. The lungs are involved in 90% of patients.

Hemophagocytic lymphohistiocytosis in adults.

Hemophagocytic lymphohistiocytosis (HLH) is an underrecognized disorder due to the variability of its presentation and the fact that in adults, its diagnosis is based on cumbersome, pediatric-based criteria. Data regarding demographics, underlying causes, clinical features, laboratory results, complications, treatments received, and clinical outcomes were collected and analyzed in 41 patients who were diagnosed and treated at University of Arkansas for Medical Sciences between 2007 and 2019. In this group, 51% were male, the median age at diagnosis was 47 years, and 85% (35/41) met the HLH-2004 diagnostic criteria (5/8 variables).

Clinical and histological response to combination nivolumab and ipilimumab in metastatic renal cell carcinoma.

Patients with renal cell carcinoma (RCC) often remain asymptomatic until the disease is advanced, with about 25% presenting at an advanced stage. We present a case of metastatic RCC treated with combination ipilimumab and nivolumab with complete radiological and pathological response. Currently, combination nivolumab and ipilimumab is a preferred option for intermediate- and poor-risk patients with clear cell stage IV RCC.

Acquired hemophilia A.

Acquired inhibitors of coagulation are a group of rare but potentially life-threatening blood disorders characterized by the presence of autoantibodies directed against clotting factor. Autoantibody against factor VIII is the most common form of clotting factor inhibitor, a condition also known as acquired hemophilia A. We present a clinical series of nine patients diagnosed and treated for acquired hemophilia A at our institution.

Nivolumab-induced immune-mediated neurotoxicity in Hodgkin lymphoma.

Nivolumab, a monoclonal antibody against programmed cell death-1 used to treat multiple cancers, has fewer side effects than traditional chemotherapy but has displayed a propensity to cause a host of immune-related adverse events. We describe a case of nivolumab immune-mediated neurotoxicity in a 42-year-old Hispanic man with relapsed Hodgkin lymphoma who presented with unilateral facial droop, dysarthria, and dysphagia 1 week after receiving nivolumab. His symptoms rapidly improved with steroids, intravenous immunoglobulin, and infliximab.

IgA vasculitis presenting as abdominal pain and rash.

A 57-year-old white man presented with acute abdominal pain and rash without any prodromal symptoms. The skin biopsy confirmed immunoglobulin A (IgA) vasculitis with small vessel vasculitis and perivascular IgA, C3, and fibrin deposition. IgA vasculitis is diagnosed most commonly in children and presents in adults in only 10% of cases.

Vitamin B12 deficiency mimicking acute leukemia.

Vitamin B12 deficiency can cause extensive hematologic alterations such as pancytopenia, macrocytosis, hypersegmentation of neutrophils, and hypercellular bone marrow with blastic differentiation. These dysplastic changes can sometimes be so profound that they mimic myelodysplastic syndromes or even acute leukemia, leading to extensive workup and aggressive treatment measures. We present a patient who was referred to our tertiary care medical center for treatment of suspected acute myeloid leukemia on the basis of peripheral smear and bone marrow biopsy findings, and induction chemotherapy was considered.

Acute myocardial infarction in a young man with large left ventricular thrombus and the antiphospholipid syndrome.

Antiphospholipid syndrome is an autoimmune disorder that presents clinically with venous and/or arterial thrombosis and can affect any organ. Coronary artery involvement and left ventricular thrombus are rare presentations. We report the case of a 23-year-old male smoker with a strong family history of premature coronary artery disease who presented with acute anterolateral ST elevation myocardial infarction and large left ventricular thrombus.

Prophylactic pre-esophagogastroduodenoscopy tracheal intubation in patients with upper gastrointestinal bleeding.

The indications for endotracheal intubation (ETI) during an esophagogastroduodenoscopy (EGD) procedure remain unclear. This study performed a descriptive analysis of patients who underwent prophylactic tracheal intubation during or before an EGD to prevent pulmonary aspiration. We selected patients with an upper gastrointestinal bleed in an intensive care unit who underwent EGD between 2000 and 2013.