New Onset Diabetes Mellitus Complicated by Hypertriglyceridemia-Induced Pancreatitis.

There is an increasing prevalence of type 2 diabetes mellitus (DM) among adolescents due to obesity. Diabetes can cause hypertriglyceridemia, defined as triglyceride (TG) levels above 150 mg/dl, leading to severe complications, including cardiovascular events, fatty liver disease, and acute pancreatitis. We present a case of acute pancreatitis manifested by both hypertriglyceridemia and new-onset DM. The risk of hypertriglyceridemia-induced pancreatitis (HTGP) significantly increases at triglyceride levels above 500 mg/dl. Both primary causes, including genetic disorders such as familial chylomicronemia, and secondary disorders of lipid metabolism, including diabetes, hypothyroidism, and pregnancy, could cause HTGP. The toxic levels of triglycerides that break into free fatty acids by pancreatic lipases are critical in pancreatitis pathogenesis. The lipotoxicity, in turn, causes systemic inflammation with further complications related to it. The clinical features of HTGP are similar to other pancreatitis causes, including abdominal pain, nausea, and vomiting. Usually, patients with HTGP tend to have worse outcomes compared to other causes. Due to too high levels of triglycerides, the serum becomes milky and causes an alteration in serum electrolytes levels, including pseudo-hyponatremia. The recommended treatment for HTGP is plasma apheresis as well as IV insulin infusion, and heparin, specifically for less worrisome patients. IV insulin potentially avoids the interventional complexities of apheresis. The usual treatment goal is to reduce the triglycerides to a safe level, and then further management is tailored to lifestyle modification and oral lipid reducing agents. Our case report explains how well insulin works in stable patients with severe pancreatitis and thus prevents associated morbidity and mortality.

Idiopathic Ovarian Vein Thrombosis: A Rare Cause of Abdominal Pain.

Ovarian vein thrombosis (OVT) is a rare entity. It is usually seen in hypercoagulable states such as pregnancy, peripartum period, active malignancy, recent pelvic surgeries, pelvic infections, and inherited or acquired thrombophilias. Idiopathic OVT is exceedingly rare. We report a case of OVT in a healthy 42-year-old post-menopausal female presenting with right lower quadrant abdominal pain for four days. The patient denied any recent pelvic surgery, pelvic infection, or any family history of thrombophilia. Right ovarian vein thrombosis was found on a computed tomography scan of the abdomen and pelvis. Laboratory workup including hypercoagulability studies was normal. The patient was treated with a therapeutic dose of lower molecular weight heparin and later transitioned to rivaroxaban for three to six months. This case emphasizes OVT as a differential diagnosis of lower abdominal pain in healthy females. Currently, there are no standard guidelines for the duration of anticoagulation in OVT, however based on literature review, deep venous thrombosis treatment guidelines can be followed.

SARS-CoV-2 Myocarditis Due to Severe Obesity.

Myocarditis is defined as a myocardial injury concomitant with myocardial dysfunction. Several causes are associated with it, including infectious versus inflammatory and inherited cardiomyopathies. It can be acute, subacute, or chronic, and it can present as focal versus diffuse myocardial dysfunction. Viruses diseases, including the Coxsackie B3 virus, have been a well-established cause of viral myocarditis. It is a significant cause of mortality typically among young individuals due to lymphocytic or granulomatous inflammation of the myocardium. At present, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a detrimental cause of myocarditis with significant mortality and morbidity. Literature has revealed that most of the individuals affected by SARS-CoV-2 have significant other comorbidities, including cardiovascular, renal, or endocrine system-related comorbidities. It is noticed worldwide that patients with hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and obesity are at a higher risk of developing severe infection. Obesity itself is related to chronic low-grade inflammation, and SARS-CoV-2 infection creates an environment of an inflammatory storm by excessive activation of cytokines, thus creating a vicious cycle of injury and organ damage. We present the case of a 33-year-old Hispanic morbidly obese male without other comorbidities diagnosed with SARS-CoV-2 pneumonia, complicated by severe systolic heart failure due to SARS-CoV-2 myocarditis.

Acute Pancreatitis: A Possible Side Effect of COVID-19 Vaccine.

For the first time, the mRNA technology was utilized to produce a vaccine against COVID-19 after the unprecedented pandemic equally affected every part of the world. Pfizer-BioNTech (BNT162b2) mRNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was granted emergency use authorization (EUA) by Food and Drug Administration (FDA) in December 2020. EUA has been widely discussed in the medical literature and the general public. The safety of the BNT162b2 vaccine has been investigated in short-term trials with data available for three months. We present a case of a 96-year-old female with a past surgical history of cholecystectomy who presented with acute onset severe abdominal pain a few days after getting the first dose of Pfizer-BioNTech COVID-19 vaccine. She was diagnosed with acute pancreatitis with a lipase level of 4036 U/L. Extensive history and investigations were unable to find any etiology. The patient was conservatively managed and discharged home without any complications. There has been some data available in medical literature showing an association between acute pancreatitis and COVID-19 infection. Trial data of Pfizer COVID-19 also shows one case of acute pancreatitis in the treatment group. There have also been individual cases of unexplained acute pancreatitis shared by medical professionals on online forums. Our main goal to write this case is to make medical literature aware of possible emerging side effects of the COVID-19 vaccine, one of such side effects being self-resolving uncomplicated acute pancreatitis.

Stewart-Treves Syndrome in Obesity-Associated Chronic Lymphedema: A Case Report.

Stewart-Treves syndrome (STS) is defined as the development of cutaneous angiosarcoma in the presence of long-standing lymphedema and is a rare disease with only about 400 cases reported in world literature. We report a case of a 63-year-old morbidly obese woman with a long-standing history of lymphedema who developed angiosarcoma of the right lower extremity with metastasis and presented with acute respiratory distress. The patient underwent a thorough laboratory workup with a chest X-ray showing bilateral effusions. The hematology-oncology service was consulted and found the patient to have significant progression of angiosarcoma causing respiratory failure and cardiac instability. A decision to transition to hospice care was made and the patient eventually passed away in the intensive care unit. We present this case to raise awareness of STS in medical literature to understand its clinical manifestations better. Early detection is imperative as angiosarcoma is commonly an aggressive disease.

Penile Mondor's Disease: Rare Association With Excessive Masturbation.

Penile Mondor's disease is a rare condition characterized by thrombophlebitis of superficial penile dorsal veins. We report a case of a 26-year-old male who developed a lump on the dorsal surface of the penis following intensive masturbation after prolonged sexual abstinence. Physical examination revealed a firm, cord-like swelling with beaded texture with no localized regional lymphadenopathy. The patient was successfully managed with non-steroidal inflammatory drugs and was symptom-free on a follow-up.