A Case of Thyroid Storm Caused by Thyroiditis.

Thyroid storm occurs when thyroid hormones are released causing a hyperadrenergic state resulting in potentially life-threatening cardio-respiratory effects. The most common cause of thyroid storm is thyrotoxicosis secondary to Graves disease. Alternatively, subacute thyroiditis (SAT) is usually a self-limited condition consisting of painful inflammation of thyroid gland, often associated with viral illness. Transient hyperthyroidism is a common finding in SAT; however, thyroid storm is an extremely rare complication of SAT. We report the sixth recorded case of SAT associated with thyroid storm.

Pyometra: An Atypical Cause of Abdominal Pain.

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint-abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

Our Guest.

An atypical encounter with a homeless man affects a physician's practice.