An Uncommon Culprit: Dural Arteriovenous Fistula Presenting as Otodynia and Dizziness.

Dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities that can present with diverse neurological symptoms. We report a case of a woman in her early 60s who presented with pain in the left ear and dizziness. Neurological evaluation and imaging studies revealed a DAVF in the left cerebellopontine angle. This case underscores the importance of considering DAVF as a potential etiology in patients presenting with atypical otological symptoms.

Immune Thrombocytopenic Purpura Secondary to Sarcoidosis.

Sarcoidosis is a systemic granulomatous disease involving multiple organs with predominantly pulmonary manifestations. Severe thrombocytopenia is a relatively rare hematologic manifestation of sarcoidosis. Immune thrombocytopenia is usually characterized by excessive antibody production leading to platelet destruction. There are a few reported cases of immune thrombocytopenic purpura secondary to sarcoidosis, but the pathophysiologic mechanism remains unknown. We report the case of a 65-year-old woman who presented severe thrombocytopenia and was found to have immune thrombocytopenic purpura secondary to sarcoidosis.

First Reported Case of Reverse Pott's Disease.

Tuberculosis, while rare, is a disease that can have several extrapulmonary manifestations. One such known extrapulmonary manifestation of disseminated TB is vertebral osteomyelitis, often referred to as "Pott's Disease." We present the case of a patient who underwent back surgery with allogenic bone graft who developed vertebral osteomyelitis and subsequently had disseminated tuberculosis, from an infected bone graft. We review current guidelines for allograft tissue screening and discuss the possible need for standardizing tuberculosis screening for bone allografts.

New onset systemic lupus erythematosus after COVID-19 infection: a case report.

COVID-19 is a respiratory viral illness that can have life threatening complications. While the short-term sequela of COVID-19, including cytokine storm, is relatively well known, the long-term complications of COVID-19 infection on the immune system is still unknown. There have been some reported cases of autoimmune disease development after COVID-19 infection. We present a patient with a history of COVID-19 infection one month prior who presented with non-specific symptoms including fatigue, malaise, bilateral lower extremity swelling and shortness of breath. His laboratory evaluation and physical exam showed him to be in acute renal failure. Further workup and kidney biopsy results confirmed systemic lupus erythematosus (SLE). Our patient needed treatment with plasmapheresis and immunosuppressants, and subsequently had significant improvement in his symptoms. We discuss the current 2019 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) diagnostic criteria for SLE and describe plausible mechanisms of COVID-19 induced lupus such as B-cell activation by the virus. We also explore the role of interferons in the potential development of autoimmune diseases after COVID-19 infection and highlight the need for further research in the area.

Breast Cancer Secondary to Radiation Therapy in a Patient With Wilms Tumor.

Wilms tumor, one of the most common childhood malignancies, is typically treated with a combination of chemotherapy, radiation, and surgical resection. Wilms tumor survivors who received radiation therapy are, however, at a higher risk of secondary malignancies and need vigilant monitoring. We present the case of a 35-year-old female with history of Wilms tumor at age five, who received radiation therapy for pulmonary metastasis, and was found to have breast cancer at the age of 35. We discuss different protocols in treatment of Wilms tumor and current secondary malignancy screening recommendations. We also recognize the importance of screening guideline awareness among primary care physicians and its mortality and morbidity implications.

Immune thrombocytopenic purpura secondary to Helicobacter pylori.

Immune thrombocytopenic purpura is a disorder characterized by decreased platelet count that may be secondary to infectious or autoimmune etiologies. We present a patient with upper gastrointestinal bleeding complicated by severe thrombocytopenia. Endoscopy revealed gastritis with pathology positive for Helicobacter pylori. Platelet count normalized after triple antibiotic therapy. The precise mechanism by which H. pylori causes immune thrombocytopenic purpura remains unclear; however, there are several plausible mechanisms. This case highlights the importance of keeping H. pylori in the differential in patients presenting with thrombocytopenia.

Elderly Onset Sarcoidosis: A Case Report.

Sarcoidosis is a multi-organ autoimmune disease that affects females more than males. While primarily considered as a disease of the young, very few cases of sarcoidosis have been reported in patients over 65 years old. We report the case of sarcoidosis in an 80-year-old female and ultimately died from sarcoidosis-related complications. We review the literature and highlight key differences in elderly onset sarcoidosis when compared to the general population. We also advise physicians to have a high index of suspicion for sarcoidosis in the elderly who present with hypercalcemia and abnormal findings on chest imaging.

Internal-Fixation Hardware Infection With Corynebacterium jeikeium.

Corynebacterium is a rare cause of prosthetic joint infections (PJIs) and infection after fracture fixation (IAFF). We present a case of a patient who developed Corynebacterium jeikeium-associated IAFF three weeks after his fracture fixation. Due to its slow-growing nature, surgical cultures remained negative after 72 hours and grew only on day 5. We highlight that physicians should have Corynebacterium-associated infection in their differential in such cases, especially when the cultures remain negative after 72 hours. We also review the literature of PJI and implant-associated infection with C. jeikeium and discuss the antibiotic resistance patterns and some microbiological considerations associated with C. jeikeium.

Nattokinase-Associated Hemoperitoneum in an Elderly Woman.

The consumption of herbal supplements has become increasingly popular the United States. One such herbal supplement that is available at pharmacies and grocery stores is nattokinase. Nattokinase, a byproduct of soybean fermentation, may have some thrombolytic properties. We present the case of a patient who developed hemoperitoneum and subsequently passed away. We review the potential mechanisms of action of nattokinase and warn against consumption of herbal supplements, especially nattokinase.

Lactobacillus-Associated Spontaneous Bacterial Peritonitis in a Liver Cirrhosis Patient on Probiotics.

The efficacy of over the counter probiotics has been an area of scientific debate. While the benefits of probiotics are heavily disputed, probiotics are considered generally safe. We present a case of a liver cirrhosis patient, who presented with hepatic encephalopathy. The patient was taking daily probiotics and receiving weekly therapeutic paracentesis. His workup revealed spontaneous bacterial peritonitis (SBP). Despite starting the patient on empiric ceftriaxone and vancomycin, the patient's leukocytosis did not improve. The paracentesis fluid and blood cultures grew Lactobacillus gasseri. Antibiotics were switched to piperacillin/tazobactam, after which the patient improved clinically. The case highlights the importance of vigilance in using probiotics, especially in liver cirrhosis patients. Also, patients with Lactobacillus-associated SBP may not improve with empiric antibiotic treatment of cephalosporins.