Autoimmune Pancreatitis Masquerading as Pancreatic Cancer: A Case Report and Literature Review.

Autoimmune pancreatitis (AIP) is a chronic fibro-inflammatory disease of the pancreas that belongs to the spectrum of immunoglobulin G-subclass 4-related diseases (IgG4-RD). It is sometimes associated with a visible pancreatic mass mimicking pancreatic cancer on imaging. The most common presentations include abdominal pain and obstructive jaundice in elderly men. Similar to other IgG4-RD, it can cause cholangiopathy, nephritis, orbital pseudotumor, and extensive lymphadenopathy. Here, we present the case of a 53-year-old female with abdominal pain and obstructive jaundice, which was diagnosed as AIP in association with significantly elevated tumor marker carbohydrate antigen 19-9 (CA 19-9). She responded to biliary decompression and steroid treatment, potentially avoiding extensive surgical intervention. On follow-up, her CA 19-9 and IgG4 levels were normalized. AIP should be high on the differential diagnosis during the evaluation of a pancreatic mass.

Portal Vein Thrombosis Secondary to COVID-19: A Rare Complication.

The novel coronavirus disease 2019 (COVID-19) pandemic has created a lasting impact in the world. It presents with various clinical manifestations, ranging from an asymptomatic state to respiratory system abnormalities, multi-organ involvement, thrombosis, and death. This case describes a 46-year-old female presenting with intractable abdominal pain leading to portal vein thrombosis (PVT), a diagnosis attributed to an unresolved COVID-19 infection.

Acute Common Iliac Artery Occlusion Secondary to Blunt Abdominal Trauma From Motor Vehicle Accident.

Blunt abdominal trauma infrequently leads to vascular injuries, and common iliac artery (CIA) injuries after motor vehicle accidents due to seat belt injury are very rare. Its posterior anatomic location and the pelvic bones usually protect the CIA. We describe a case of a young female presenting with acute blunt trauma to the abdomen after being a restrained driver in a motor vehicle accident and was found to have acute left CIA occlusion. The purpose of this case is to stress the importance of maintaining a high index of suspicion for vascular injuries in blunt abdominal trauma; we recommend early imaging diagnosis and timely treatment to mitigate its complications.

Linezolid Induced Lactic Acidosis: The Side Effect, Clinician Should Be Aware of.

Linezolid is a synthetic antibiotic that functions through the inhibition of bacterial protein synthesis by binding to ribosomal ribonucleic acid (rRNA). Deliverable in both intravenous and oral form, with a low level of resistance amongst Methicillin-resistant Staphylococcus aureus (MRSA) strains, it is recommended for a wide range of gram-positive infections. We present a case of a male patient who underwent endovascular abdominal aortic aneurysm repair complicated by abdominal sepsis due to bowel ischemia; several days after linezolid therapy was initiated, he presented with signs of lactic acidosis. After excluding other sources such as metabolic, hypoxia, or organ damage, the resulting lactic acidosis was determined to be a side effect of linezolid.

Peripheral Embolization of Left Ventricular Thrombus Leading to Acute Bilateral Critical Limb Ischemia: A Rare Phenomenon.

Left ventricular thrombus (LVT) is a well-known complication of myocardial infarction (MI) leading to significant morbidity and mortality. LVT can also lead to systemic thromboembolic events causing threatening limb ischemia. We report a rare case of critical bilateral limb ischemia that resulted from peripheral embolization of LVT post MI, which was managed successfully by emergent surgical intervention and anticoagulation. A 74-year-old male with a medical history of hypertension, diabetes, hyperlipidemia and coronary artery disease status post stenting of the left anterior descending and left circumflex arteries presented to the emergency department with typical chest pain and progressive shortness of breath. Cardiac troponin levels on admission were 35 ng/mL of blood. The patient subsequently underwent emergent cardiac catheterization which revealed significant triple vessel disease, and was referred for coronary artery bypass grafting (CABG) surgery. Transthoracic and transesophageal echocardiograms revealed the presence of an apical aneurysm with chronic organized mobile thrombus at the apex. Post CABG, the patient complained of excruciating right leg pain. Computed tomography (CT) angiogram of the abdominal aorta and lower extremities revealed a large embolus at the aortic bifurcation occluding the right and nearly occluding the left common iliac arteries and thrombus in the right popliteal artery. He underwent emergent vascular surgery with resolution of his symptoms and remained without further complications. The incidence of LVT remains high in post-MI patients, and complications of LVT are known to include thromboembolic events. Peripheral embolization of acute or chronic LVT leading to bilateral distal embolization and critical limb ischemia remains a rare occurrence. This case report aims to aid clinicians to recognize and promptly manage LVT and related arterial thromboembolic events with anticoagulation and emergent surgical intervention if limb ischemia develops.