A Rare Hemorrhagic, Orange-Colored Ascites, Challenging Traditional Ascitic Fluid Analysis.

Analysis of ascitic fluid can offer useful information in developing and supporting a differential diagnosis. As one of the most prevalent complications in patients with cirrhosis, ascitic fluid aids in differentiating a benign condition from malignancy. Both the gross appearance of the ascitic fluid, along with fluid analysis, play a major role in diagnosis. Here, we discuss a patient with liver cirrhosis, esophageal varices, hepatitis C, and alcohol abuse, who had a paracentesis performed, which revealed a turbid, viscous, orange-colored ascitic fluid that has not been documented in literature. Ascitic fluid is routinely analyzed based on gross appearance, cell count, and serum ascites albumin gradient (SAAG) score. An appearance of turbidity or cloudiness has commonly suggested an inflammatory process. In our case, fluid analysis revealed a red blood cell count of 24 250/mcL, further suggesting inflammation. However, it also revealed an insignificant number of inflammatory cells, with a total nucleated cell count of 14/mcL. This rich-orange color has posed a challenge in classification and diagnosis of the underlying cause of ascites, with one classification system suggesting inflammation, while another suggesting portal hypertension. Furthermore, we have traditionally relied on the SAAG score to aid in determining portal hypertension as an underlying cause of ascites. With a 96.7% accuracy rate, the SAAG score incorrectly diagnosed portal hypertension in this patient. In this article, we aim to explore how this rare, orange-colored ascitic fluid has challenged the traditional classification system of ascites.

From a Machine Saw to a Case of Mycobacterium Fortuitum Pyomyositis.

Pyomyositis is a bacterial infection occurring mainly in skeletal muscles. It is most commonly caused by Staphylococcus aureus with initial symptoms including muscle pain, swelling, and site tenderness. When available, the most accurate technique to determine the extent and the specific location of disease is the magnetic resonance imaging. Successful management includes early recognition, timely surgical debridement or drainage, and appropriate antibiotic therapy. This case report describes a case of Mycobacterium fortuitum pyomyositis in an elderly male associated with challenges of successful diagnosis.

Cannabis-Induced Pancreatitis in a Young Adult Male.

Drugs account for 2% of all the causes of acute pancreatitis. To date, there are approximately 26 reported cases of acute pancreatitis associated with the use of cannabis. We report the case of a 20-year-old male who presented with intractable nausea, vomiting, and epigastric pain and a lipase level of 1541 with reportedly no alcohol use, and no evidence of medication, biliary, or autoimmune etiology. However, the patient did endorse heavily smoking cannabis prior to symptom onset. He was instructed to abstain from cannabis use on discharge and has not presented to the hospital since this episode. The reporting of this case aims to increase awareness of cannabis as a differential diagnosis in cases of pancreatitis that is not due to typical etiologies such as gallstones, medications, and alcohol use. There has yet to be definitive evidence as to how cannabis can cause pancreatitis. Further studies must be conducted to better understand the association between cannabis use and acute pancreatitis and the mechanism by which cannabis affects the pancreas.

Multivalvular Endocarditis Involving 3 Valves in a Nonsurgical Candidate.

Infective endocarditis is associated with high morbidity and mortality. Hence, early diagnosis and prompt intervention is crucial. Multivalvular endocarditis involving 3 or more valves is rarely reported with little information regarding best management or prognosis, particularly in nonsurgical patients. Conflicting guidelines regarding medical versus surgical treatment in multivalvular endocarditis exist with few studies describing the outcome of medically managed patients. We report the case of a previously healthy male presenting with infective endocarditis involving 3 valves further complicated by multiple septic emboli and deemed a nonsurgical candidate.

Colonic Adenocarcinoma Presenting as Splenic Abscess Secondary to Suspected Microperforation.

Splenic abscesses are a rare infection that usually requires seeding from another primary source; however, direct contact of bacteria can occur with microperforation secondary to colon cancer leading to abscess formation. This occurrence is rare, and through literature review only 12 previous cases have been reported with associated bacteremia. Our patient is a 62-year-old female who presented with left upper quadrant pain with a history of tobacco and alcohol abuse that was febrile and hypoxic. Blood cultures were obtained that eventually grew Fusobacterium mortiferum. Computed tomography of the abdomen and the pelvis revealed 2 splenic abscesses that were cultured to grow Escherichia coli and ß-hemolytic Streptococcus group C. Colonoscopy was performed, which identified 2 masses that were biopsied, and histopathology confirmed well-differentiated adenocarcinoma with possible muscular invasion. The patient had no other identifiable risk factors for bacterial seeding from another primary source. We present the first reported case report of splenic abscess secondary to colonic adenocarcinoma suspected microperforation associated with Fusobacterium mortiferum bacteremia.

The Coincidence of 2 Epidemics, Coccidioidomycosis and SARS-CoV-2: A Case Report.

In the middle of a pandemic, patients with cough and fever are thought to have SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). It should be remembered that in the desert southwest of the United States, we have an ongoing epidemic of coccidioidomycosis (CM). There are additionally many other respiratory illnesses that could be confused with CoV-2 or overlooked. This is a case report of CoV-2 engrafted on chronic cavitary pulmonary CM. In a time where the coronavirus pandemic is becoming rampant, we demonstrate the case of a coinfection with cavitary pulmonary CM. In this case, the importance of detection of the coronavirus and treatment of the coinfection is explored.

Results of ALIVE: A Faith-Based Pilot Intervention to Improve Diet Among African American Church Members.

BACKGROUND: A key intervention to address Black-White health disparities in cardiovascular disease (CVD) is to improve diet quality, especially vegetable consumption, among African Americans. However, effective and sustainable interventions are lacking for this population. OBJECTIVE: Conduct a proof-of-concept study to measure the feasibility of implementing and rigorously assessing a novel, culturally tailored church-based intervention to improve vegetable consumption and total diet quality among African Americans. METHODS: The study was designed and implemented by a community-based participatory research (CBPR) partnership between researchers, pastors, and church leaders. The Abundant Living in Vibrant Energy (ALIVE) intervention included a Bible study and small group-based nutrition education delivered by pastors and church members in 24 two-hour sessions over 9 months as well as church-wide activities. Overall, 206 people enrolled across five African American churches. RESULTS: Participants attended 56% of sessions. The mean number of daily vegetable servings at baseline was 3.04; this increased by one serving at the 9-month follow-up (p < .001). Vegetable servings increased by more than one in 47% of participants. Total diet quality also increased (p < .01) and significant reductions were found in weight (-1.0 kg; p < .001), systolic blood pressure (-3.91 mm Hg; p = .002), and diastolic blood pressure (-2.18 mm Hg; p = .001). CONCLUSIONS: The ALIVE intervention was flexibly adapted by a range of churches; successfully implemented by pastors, deacons, and church leaders; and rigorously evaluated across a range of church settings. Further study of this intervention is warranted given the evidence for potential efficacy and a high level of external validity.

A Case of Recurrent Bacterial Meningitis Due to Retained 54-Year-Old Ureterodural Anastomosis.

Ventriculoperitoneal shunts are the current treatment of choice for congenital hydrocephalus. It is rare for physicians to see patients with alternative types of shunting devices. Lumboureteral shunts, once popular from the 1940s to 1960s, decompress via the genitourinary system. Immediate complications were dehydration, electrolyte imbalances, infection, and the sacrifice of a functional kidney. Long-term complications include retrograde meningitis due to urinary tract infections. Three shunt types have been documented: polyethylene, silicone rubber, and ureterodural anastomosis. Routine imaging cannot detect a ureterodural anastomosis, and if suspected, computed tomography myelogram is needed for confirmation. This article presents the case of a man with long-standing ureterodural anastomosis that required ligation after recurrent episodes of acute meningitis secondary to urinary retention.