A Case Report of Neuropathic Arthropathy in Chronic Syrinx Raising Suspicion of Malignancy.

Syringomyelia is a prevalent cause of Charcot arthropathy, notably affecting the elbow and less frequently the shoulder. Before attributing neuropathic arthropathy (NA) to a syrinx, careful investigation of various potential causes is vital. We present a unique case of NA affecting the left shoulder, secondary to a longstanding syrinx presenting as an expansile mass on imaging, raising suspicion of malignancy. The patient presented with progressive left arm swelling, limited mobility, and a history of chronic left shoulder pain. Through clinical evaluation and imaging, including X-rays and CT scans, significant bone destruction and a large fluid-filled mass in the left shoulder were observed. Laboratory tests ruled out other potential diagnoses, and a bone biopsy excluded malignancy. This study emphasizes the importance of thorough differential diagnosis and appropriate imaging techniques to distinguish NA from other conditions. The diagnosis of NA relies on a comprehensive assessment involving clinical signs, symptoms, radiological imaging, and additional tests aimed at excluding other potential causes, including soft tissue tumors. Management strategies, including conservative approaches and surgical interventions like neurosurgical decompression and shoulder arthroplasty, are discussed. The study sheds light on the challenges in diagnosing and managing NA associated with syringomyelia and emphasizes the significance of a multidisciplinary approach for optimal outcomes.

Navigating the Diagnostic Challenges of Mycoplasma and Legionella Coinfection Through Serological Testing.

Diagnosing community-acquired pneumonia (CAP) is increasingly challenging, especially with the emergence of atypical pathogens such as Mycoplasma pneumoniae and Legionella pneumophila. This report presents the case of a 60-year-old male exhibiting lethargy and decreased oral intake, with a medical history marked by chronic kidney disease and benign prostate hyperplasia. Despite a positive Legionella urine antigen, the clinical and radiological profile did not align with Legionella pneumonia. Elevated M. pneumoniae IgM antibody titers further complicated the diagnostic scenario. We explore the complexities of distinguishing coinfection from primary infection, highlight the limitations of serological testing, and promote a comprehensive diagnostic strategy customized to individual patient circumstances. This case emphasizes the importance of comprehensive assessment strategies to understand atypical pneumonia presentations, particularly within complex clinical scenarios.

Plasmodium falciparum Malaria Presenting as a Thrombotic Thrombocytopenic Purpura (TTP) Mimic: A Case Report.

Malaria can present with clinical manifestations overlapping with thrombotic thrombocytopenic purpura (TTP). We present the case of a 55-year-old female who presented with abdominal pain, fever, confusion, dehydration, and recent travel to Nigeria. Laboratory investigations were remarkable for low hemoglobin, decreased platelets, and elevated lactate. Suspicion for TTP occurred when the patient's platelet count and hemoglobin progressively decreased along with acute kidney injury and confusion. There was an elevated ADAMTS13 antibody level and mildly reduced ADAMTS13 activity suggesting possible TTP. However, Plasmodium falciparum was seen on peripheral blood smears. Treatment with artemether-lumefantrine was initiated which led to improvement in parasitemia, platelet count, and anemia. The similarity between malaria and TTP is mostly explained by thrombotic microangiopathic anemia (TMA) present in both diseases. Awareness of the common pathogenesis of TMA in both diseases and clinical judgment are pivotal in determining the timely initiation of appropriate treatment.

Septic thrombophlebitis of portal and splenic vein secondary to Fusobacterium nucleatum: A case report of an abdominal variant of lemierre syndrome.

RATIONALE: Septic thrombophlebitis of the internal jugular vein also known as Lemierre syndrome occurs secondary to an oropharyngeal infection often leading to septic embolisms to distant sites. Anaerobic gram-negative bacillus, Fusobacterium nucleatum and Fusobacterium necrophorum are commonly isolated organisms. Fusobacterium species has also been reported to complicate an intra-abdominal infection leading to septic thrombophlebitis of portal vein also known as pylephlebitis or abdominal variant of lemierre syndrome. PATIENT CONCERNS: The patient was a middle-aged female patient with chief complaints of abdominal discomfort, intermittent fever and vomiting for one month. DIAGNOSES: The final diagnosis was septic thrombophlebitis of portal and splenic vein secondary to Fusobacterium nucleatum. INTERVENTIONS: Patient was managed with broad spectrum intravenous antibiotics with coverage against gram-negative bacilli, anaerobes, and aerobic streptococcus species with therapeutic anticoagulation. OUTCOMES: Patient gradually improved and was discharged on oral apixaban. She was instructed to follow up with gastrointestinal specialist upon discharge in anticipation of the need for liver transplant in future. LESSONS: Due to its high mortality and associated long term disease morbidity, clinicians should always strive towards early diagnosis and treatment of the condition with involvement of multidisciplinary teams.

A Rare Case of Valproic Acid Toxicity Requiring Hemodialysis.

Valproic acid poisoning can have mild to fatal consequences depending on its body concentration. There are rare case reports and barely any known controlled studies on the use of hemodialysis as a last treatment resort. We report a rare valproic acid poisoning case at One Brooklyn Health/Interfaith campus, New York City, warranting intubation and hemodialysis. The patient is a 47-year-old male with a past medical history of seizure disorder, polysubstance use disorder, schizophrenia, and gastroesophageal reflux disease (GERD) who was brought to the medical emergency department (ED) for intentional valproic acid overdose with 60 tablets of his prescribed home Depakote DR 500 mg (~30 g). The patient's other outpatient medications included valproic acid, trazodone, acetaminophen, famotidine, fluoxetine, folic acid, hydrocortisone-aloe, multivitamin, nicotine polacrilex, and thiamine. The patient's initial blood tests showed high valproic acid, ammonia, ethanol, and lactate. About six hours after ED admission, the patient became somnolent, desaturated to 74% on a non-rebreather oxygen mask, warranting intubation and hemodialysis after noticing persistently high serum concentrations of valproic acid. The relatively low molecular weight (144 Daltons) and low volume of distribution of valproic acid suggest a potential benefit from hemodialysis, especially at a serum concentration of >850 mg/L or in the event of a shock. In this patient, mentation and stability status were improved after hemodialysis. Hemodialysis appears to be the last treatment resort for severe valproic acid poisoning.