A Case of Lynch Syndrome-Associated Colorectal Adenocarcinoma in a 19-Year-Old Female Patient.

This case report presents the diagnostic journey and management of a 19-year-old female who was diagnosed with advanced colorectal cancer (CRC) associated with Lynch syndrome (LS), a hereditary nonpolyposis colorectal cancer (HNPCC). The patient initially presented with complaints of persistent abdominal pain, vomiting, and unexplained weight loss, leading to investigations revealing hypochromic microcytic anemia and the presence of an inhomogeneous pelvic mass associated with the sigmoid colon. Subsequent diagnostic procedures, including flexible sigmoidoscopy and pathology reports, confirmed the presence of an advanced rectosigmoid adenocarcinoma with high-grade dysplasia. Molecular testing and immunohistochemical staining revealed a deficiency in mismatch repair proteins, confirming the diagnosis of LS. Despite ineligibility for certain clinical trials due to lymph node infiltration, the patient demonstrated a significant positive response to pembrolizumab immunotherapy, with a notable reduction in tumor size and lymph node involvement. This case underscores the significance of genetic predisposition in the development of early-onset CRC and the potential efficacy of immunotherapy in managing advanced CRC associated with LS in young patients. Additionally, this case provides insights into the evolving landscape of CRC management and the critical role of personalized treatment strategies in optimizing patient outcomes.

Fish Hook as Foreign Body: Not All Foreign Bodies Can Be Fished Out of the Esophagus With Endoscopy Alone.

A 75-year-old male presented to the hospital with acute onset of neck pain. Although the patient did not report known ingestion of a foreign body, there was evidence of a fish hook in the cervical esophagus on plain neck radiography. Due to the location at the upper esophageal sphincter in the hypopharynx, the foreign body was not retrievable by endoscopy alone and required better visualization and airway protection with direct laryngoscopy and rigid esophagoscopy. A fish hook was promptly retrieved within 24 hours of the patient's presentation and his symptoms resolved without complications. We report this unusual case to emphasize the importance of proper food preparation, thoroughly chewing food before swallowing, and prompt management of foreign body ingestion in adults.

A Case Report on an Underappreciated Cause of Heart Failure: Chronic Viral Myocarditis.

A 64-year-old male with a history of congestive heart failure (CHF), coronary artery disease status post two stents in 2014, hypertension, and chronic kidney disease (CKD) stage III, was admitted for acute exacerbation of CHF. Treatment started with blood pressure control and high-dose diuretics. While the patient's volume status improved, his clinical status declined, and he required a dobutamine infusion. Cardiac catheterization revealed nonischemic cardiomyopathy. He was ultimately found to have myocarditis secondary to chronic Coxsackie B infection. A comprehensive investigation ruled out other potential etiologies. This case highlights how viruses continue to be an underappreciated cause of heart failure. Infectious agents should not be underestimated as several types of viral infections carry substantial cardiovascular risks, potentially leading to significant deterioration in decompensated patients.