Multiple Myeloma as a Potential Cause of Low Complements in Patients With Acute Kidney Injury.

Multiple myeloma (MM) is a plasma cell malignancy belonging to the class of monoclonal gammopathies that leads to end-organ damage myeloma events that encompass anemia, the presence of lytic bone lesions, hypercalcemia, and renal insufficiency. However, there are very few reported cases of patients with low complements in the context of MM and renal failure. Traditionally, low complements in glomerular disease are associated with conditions such as membranoproliferative glomerulonephritis, cryoglobulinemia, systemic lupus erythematous, and post-infectious glomerulonephritis. Despite its rarity, physicians should maintain a high degree of suspicion and consider MM as a potential cause of low complements in patients with renal injury. In this case report, we present a patient with a history of MM associated with acute kidney injury with hypocomplementemia, an atypical presentation of myeloma in MM.

End-Stage Achalasia With Megaesophagus Refractory to Two Heller Myotomies.

Achalasia is a motility disorder of the esophagus in which the lower esophageal sphincter fails to relax. Megaesophagus is a rare complication of achalasia characterized by severe dilatation of the esophagus, often indicative of end-stage achalasia. Typical presenting symptoms include dysphagia, nausea, vomiting, weight loss, and chest pain. The majority of patients with achalasia typically have excellent outcomes after surgical intervention with Heller myotomy. We discuss an interesting case of unsuccessful surgical intervention and hypothesize the reason for its failure in our patient.

Ischemic Colitis in a Young Female Following Herbal Supplement Ingestion.

Ischemic colitis is typically considered a disease of the elderly, given their atherosclerotic risk factors and other comorbidities. Ischemic colitis in the younger population is considered very uncommon. We present an interesting case of a young female presenting with abdominal pain and hematochezia found to have ischemic colitis on pathological biopsy results after a colonoscopy. She was an otherwise healthy female with no medical problems prior to her hospitalization but endorsed recent use of a bitter herbal tea to relieve her symptoms. Here, we review potential causes of ischemic colitis, including herbal remedies, which have been linked to causing hypercoagulable and hypotensive states.

Esophagogastrectomy for Long-Segment Recurrent Esophageal Stricture Following Hyperemesis Gravidarum.

An esophageal stricture is an abnormal tightening of the esophageal lumen. Benign strictures are often caused by gastroesophageal reflux disease (GERD) and are more common in patients over 40 years. When caused by GERD, these strictures develop when acid from the stomach regurgitates into the esophagus, leading to inflammation, fibrosis, and eventual narrowing of the lumen. This case report aims to highlight the importance of obtaining a detailed history in discovering the underlying cause of these strictures. We present a unique case of a young female presenting with dysphagia several months after experiencing Hyperemesis gravidarum. She was found to have a long esophageal stricture that would eventually recur within a few weeks of therapeutic intervention. The pathological report confirmed benign disease, but she ultimately would require surgical intervention for her condition.