Type B Lactic Acidosis: A Very Rare but Fatal Complication of Gastrointestinal Solid Tumor.

Type B lactic acidosis, secondary to solid cancer, is very rare. It is mostly seen in patients with hematological malignancies. Although its exact pathogenesis is unknown, it is believed to be caused by overproduction and the inability of tumor cells to remove lactate. In the last 26 years, a systematic review of the literature only identified two previous reports of colorectal cancer-related type B lactic acidosis. Here, we report the third case of severe type B lactic acidosis due to stage IV colorectal with liver metastasis. Besides, this case is unique in that serum lactate levels reaching as high as 24 mmol/L were not reported in association with colorectal cancer. In most cases, the prognosis is still very poor because there are no standardized treatment recommendations. Early chemotherapy is still the only intervention that provides some survival benefits.

Acute Acalculous Cholecystitis Due to COVID-19, an Unusual Presentation.

Although the Coronavirus Disease 2019 (COVID-19) infection mainly affects the lung, its gastrointestinal (GI) involvements are also well-known, especially hepatic involvement presenting as mild to moderate transaminitis. However, COVID-19 infection presenting with gall bladder involvement with acalculous cholecystitis is extremely rare in the medical literature. So far, only two cases have been reported, and herein, we are reporting the third case of a patient who developed COVID-19 presenting as an acute acalculous cholecystitis.

Intestinal angioedema caused by an acquired C1 esterase inhibitor deficiency associated with underlying splenic marginal zone lymphoma.

A 75-year-old woman presented with recurrent abdominal pain and vomiting for 1 year and was later found to have splenomegaly and pancytopenia. This case report depicts a clinical picture of intestinal angioedema, a challenging diagnosis, and an underlying rare syndrome of acquired C1 esterase inhibitor deficiency associated with splenic marginal zone lymphoma.

Atypical Presentation of Fatal Disease: Painless Aortic Dissection.

Aortic dissections (ADs) are uncommon but they are highly lethal. Due to atypical signs and symptoms, diagnosis of type B AD can be easily missed or delayed. Our patient presented to the emergency center with dizziness and fall for which he was evaluated and treated for hypertension. Two weeks later, he again presented to the hospital with painless right groin swelling: computed tomography (CT) of the abdomen incidentally showed type B AD. The patient might have an AD presenting with dizziness and hypertension during previous presentation. From this case, we learn how it is challenging to diagnose painless AD especially when patient comes with atypical symptoms. In high-risk patients with unexplained dizziness and fall, a high degree of suspicion may help for early diagnosis and management.

Relation between mean platelet volume and C-reactive protein.

Mean platelet volume (MPV) is a measure of platelet activation, and C-reactive protein (CRP) is an established marker of inflammation. Studies on the correlation between MPV and CRP have produced ambiguous results. We undertook a population study with the National Health and Nutrition Examination Survey (NHANES) data (2005-2010) to investigate the relationship between CRP and MPV. CRP was analyzed both as a continuous variable and as a categorical variable (low, intermediate, or high). Multivariate ordinary least squares regression analysis was used to predict the association. Statistical analyses were performed with Stata MP 15.1. In 16,329 participants, mean MPV was 7.9 fL (standard deviation 0.87). Overall mean CRP in the population was 0.4 mg/dL (standard deviation 0.78). In adjusted regression models with CRP as a continuous measure, individuals with high CRP had significantly lower MPV (b = -0.04; standard error 0.01; 95% confidence interval -0.06 to -0.01; P = 0.002). In adjusted regression models using CRP categories, participants with high CRP (>3 mg/dL) had significantly lower MPV compared with the low CRP group (b = -0.20; standard error 0.09; 95% confidence interval -0.38 to -0.01; P = 0.035). Our study revealed a significant inverse correlation between MPV and CRP in NHANES participants.

Primary Pancreatic Large B-Cell Lymphoma Presenting as Acute Pancreatitis.

Primary pancreatic lymphoma (PPL) is an extremely rare form of extranodal malignant lymphoma. The most common histological subtype of PPL is diffuse large B-cell lymphoma (DLBCL). Clinical and imaging features of PPL may often overlap with pancreatic adenocarcinoma. Therefore, it is very important to obtain a preoperative cytohistology diagnosis of pancreatic tumors to avoid unnecessary surgeries in cases with a diagnosis of PPL. Herein, we report a 71-year-old male who was admitted to our hospital with a diagnosis of acute pancreatitis after he presented with complaints of nausea, vomiting, and epigastric abdominal pain. MRI of the abdomen revealed a pancreatic head mass, and histopathology and immunohistochemical assessment of the pancreatic lesion established the diagnosis of DLBCL. The patient achieved remission after six cycles of rituximab-cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine (oncovin), prednisolone (R-CHOP) chemotherapy.

Pica/Pagophagia-Associated Hyponatremia: Patient Presenting With Seizure.

Pica is an unusual condition in which patients crave and chew substances with no nutritional value. Ice pica (pagophagia) is commonly seen in patient with iron deficiency. People chew ice cubes or add ice to their drinks to cool or refresh themselves, and they may not consider this as an abnormal behavior. Excessive ice chewing/eating can have significant health risks, including electrolyte abnormalities and metabolic disorders. We report a patient admitted to our hospital with severe hyponatremia and seizures due to iron deficiency-associated pagophagia. Ice pica leading to hyponatremia and seizure is not commonly seen in clinical practice. It was a challenging case and the patient was seen and investigated at outpatient clinic for polyuria, though an underlying cause was not identified. Patients may be secretive or reluctant to mention their pica habit. Studies have also shown that most physicians are unaware of pica and most cases can be easily missed.