A case report of carbamazepine-induced oropharyngeal dysphagia in a patient with primary progressive multiple sclerosis.

Seventy-year-old male with primary progressive multiple sclerosis that had a severe episode of oropharyngeal dysphagia following initiation of carbamazepine. He was being treated for trigeminal neuralgia. Four days after discontinuation of carbamazepine resulted in a complete resolution of the patient's dysphagia, and he returned to baseline.

A Case of Synchronous Primary Tumors of the Left Ovary and Uterus.

BACKGROUND Synchronous tumors occur when 2 separate primary tumors are diagnosed within 6 months. They can originate from the same site or different locations. For example, synchronous primary tumors of uterine and ovarian origin are a common type. Diagnosis can be challenging, however is critical to determine whether a patient has multiple primary tumors or a single tumor with metastasis to guide effective treatment. Compared with endometrial cancer that has spread to the ovary, synchronous primary tumors of the uterus and ovaries typically require less aggressive treatment. CASE REPORT A 45-year-old woman with nonspecific symptoms of headache and confusion had imaging studies that revealed a neoplasm in her brain, which was likely causing her symptoms. The masses were metastatic lesions, and the primary cancer was determined to be synchronous endometrial ovarian cancer (SEOC). She underwent bilateral frontal craniotomy for tumor resection and diagnostic tests. She had an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. She was stable during hospitalization but lost to follow-up after discharge. CONCLUSIONS Regular gynecologic examinations, including bimanual palpation of the ovaries during cervical cancer screenings, are essential for detecting cancer early and improving chances of recovery. This case also highlights the indolent growth and high risk of metastasis associated with SEOC. Although this type of cancer is rare, patients with it can be at increased risk of developing metastatic lesions in other parts of their bodies. To manage synchronous tumors effectively, a multidisciplinary approach and close collaboration between medical professionals are necessary to ensure best patient outcomes.

A Case of Statin-Associated Autoimmune Myopathy: Management and Treatment.

Elevated lipid panels are associated with an increased risk of cardiovascular disease. Management of heart disease with lipid lowering agents play a vital role in medicine. Statins are one group of medications that are widely utilized in the medical field to decrease the risk of atherosclerotic disease. Statins work by inhibiting the hepatic enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Although statins are one of the most effective drugs for secondary and primary prevention of heart disease, they are not without risks and side effects such as hepatotoxicity and myopathy. We present a case of a male patient who developed progressively worsening muscle weakness and elevated muscle enzyme markers upon initiation of a statin. His symptoms persisted despite a trial of an alternative statin and subsequent discontinuation of all statin medications. A multitude of possible etiologies were considered and ranged from infectious, autoimmune, cancerous, to congenital in nature. Environmental factors, such as exposure to medications or toxins, were also considered as one of the possible precipitating factors. The association between his statin consumption and muscle weakness were not easily apparent at first. He required further workup including physical examination, electromyography, panel of myositis antibodies, and muscle biopsy. After clinical suspicion and elevated antibodies to HMGCR beyond the normal limit, he was discovered to have statin-associated autoimmune myopathy. The patient improved with the treatment of immunosuppressive agent's prednisone and methotrexate.

The Mystery of a Unilateral Headache Ultimately Diagnosed as Moyamoya Disease.

Moyamoya disease (MMD) is a rare chronic cerebrovascular occlusive disease characterized by progressive stenosis or occlusion of the intracranial internal carotid arteries and their proximal branches, with subsequent abnormally formed collateral vessels. Moyamoya disease is typically found in children of East Asian descent and is the most common pediatric cerebrovascular pathology in East Asian populations. However, moyamoya disease can be present without any predisposing factors, and this is what distinguishes the disease from the syndrome. Moyamoya syndrome is typically associated with other conditions such as sickle cell disease or neurofibromatosis. The syndrome can also be seen in patients who have had exposure to cervical or neck radiation. We present a rare case of an adult Peruvian woman who initially presented with a severe right hemispherical headache, which was ultimately diagnosed as MMD. This report and the discussion aim to provide more understanding of moyamoya disease and how it can be incidentally discovered in an unsuspected patient without any predisposing factors. The fact that the patient lacked any predisposing factors makes moyamoya disease, and not the syndrome, the diagnosis. Currently available treatments are limited. One specialized therapeutic approach is a procedure called encephaloduroarteriosynangiosis (EDAS), which aims to involve the transposition of a segment of a scalp artery onto the surface of the brain to permit the additional formation of collateral arteries. We aim to highlight the management and treatment of a case of moyamoya presenting as a severe right hemispherical headache in a patient without any predisposing factors.

Evaluation of Recurrent Right-Sided Pleural Effusion: Hepatic Hydrothorax vs. Silicone Breast Implant Rupture.

We report a case of a 55-year-old woman who presented to our hospital emergency department with a recurrent right-sided pleural effusion. Her presenting symptom was shortness of breath which first began two years prior after she experienced a blunt thoracic injury. This injury resulted in the rupture of her right silicone breast implant. Since the traumatic rupture of her right breast implant, she developed asthma-like symptoms and allergies that were adequately controlled with bronchodilators, antihistamines, and glucocorticoids. Laboratory investigation was significant for elevated immunoglobulin E (IgE) levels and eosinophilia consistent with an allergic hypersensitivity reaction. She denied a history of smoking, asthma, or allergies preceding the trauma to her right breast implant. Our differential diagnosis also included the possibility of an inflammatory reaction to the silicone breast rupture as a possible etiology for the recurrent pleural effusion. The patient underwent a right-sided diagnostic and therapeutic thoracentesis procedure on two separate occasions within a span of a month in an effort to improve her symptoms and arrive at a definitive diagnosis. Her worsening symptoms were believed to be triggered by the pleural effusion. Aspirated pleural fluid was sent to the laboratory for analysis. Both samples excluded infectious or malignant causes of the pleural effusion. Ultimately, the source of her pleural effusion was determined to be decompensated liver cirrhosis. The patient underwent a pleurodesis procedure in an effort to seal the pleural space.

Diagnosis of the Primary Tumor Site in the Case of Liver Metastatic Carcinoma.

Immunohistochemical markers have been frequently utilized as a diagnostic tool in pathology to help in diagnosing malignancy of unknown primary sites. In previous cases, the immunohistological expression of cytokeratin 7 (CK7), Napsin A, and thyroid transcription factor-1 (TTF-1) has helped identify and diagnose primary malignancy as originating from the lung. This case report describes an elderly woman with a liver metastasis consistent with a lung primary and illustrates the utility and importance of tissue-specific markers as a diagnostic tool in the evaluation of unknown primary tumors.