IgG4-negative pituitary inflammatory pseudotumor with sphenoidal involvement resembling a macroadenoma.

BACKGROUND: Inflammatory pseudotumors (IPTs) are rare benign conditions of unknown etiology that can affect any part of the body. IPTs are most commonly associated with Immunoglobulin G4 (IgG4)-related disease. Central nervous system IPTs, especially with pituitary involvement, are even rarer entities. The presence of an IgG4-negative pituitary IPT with simultaneous extracranial involvement has not been reported. CASE REPORT: We present the case of a 41-year-old female with past medical history of rheumatoid arthritis and a diagnosis of pituitary IPT with coexisting sphenoidal (extracranial) involvement mimicking a pituitary macroadenoma at presentation. The patient underwent multiple consecutive biopsies, and an extensive workup prior to establishing the diagnosis. Laboratory work-up showed normal serum IgG4 and unremarkable liver function tests. CONCLUSION: Pituitary lesions with simultaneous sphenoidal involvement in patients with IgG4-negative systemic inflammatory disease should raise the clinical suspicion for intracranial IPTs, as these tumors can mimic aggressive counterparts causing adjacent bony erosion, and local invasion.

Chronic Pilonidal Cyst with Malignant Transformation: A Case Report and Literature Review.

A 63-year-old male with a 20-year history of a chronic, recurrent sacrococcygeal pilonidal cyst was referred to our outpatient clinic. He had received multiple surgical resections in the past with benign pathology. He presented with a verrucous wart-like midline mass on the superior gluteal cleft that had grown since his last resection. The patient subsequently underwent resection of the mass with bilateral gluteal rotational flaps. Pathology showed squamous cell carcinoma with tumor-free margins, and further imaging showed no evidence of metastatic disease. It is believed chronic inflammation with subsequent genetic and impaired DNA repair mechanisms is the leading cause of malignancy. The treatment of choice for pilonidal carcinoma is surgical resection with free margins. Reconstruction methods can be utilized to repair the tissue defect. Pilonidal carcinoma has high mortality risk with surgical treatment yielding a disease-free 5-year survival rate of 55% of patients and a high recurrence rate of 50%. The role of chemoradiotherapy is currently unclear.

Acute Gastric Dilatation Complicated by Necrosis and Perforation Following a Binge Eating Episode.

Acute gastric dilatation is a rare entity limited to case reports in the literature. It is characterized by significant distention of the stomach beyond physiologic parameters. The sequelae of this phenomenon are life-threating, as it can lead to gastric perforation. It is frequently reported in patients who suffer from eating disorders, particularly binge eating disorder and bulimia nervosa. We present a case of a 28-year-old female who suffered from acute gastric dilatation following significant food intake. Her long hospital course was complicated by gastric necrosis and perforation, requiring multiple laparotomies prior to the restoration of a functional gastrointestinal tract. We aim to demonstrate the true gravity of this diagnosis and raise its awareness.

Surgical Management of Emphysematous Gastritis in a Postpartum Female: A Case Report and Literature Review.

Emphysematous gastritis is a form of gastritis characterized by both gastric inflammation and the presence of intramural gas. Its occurrence is rare, and its presentation is non-specific. Consequently, no definitive guidelines for management have been outlined. We herein detail the diagnosis and surgical management of a female with complicated emphysematous gastritis following a cesarean section delivery. In light of the gastric ischemia noted on esophagogastroduodenoscopy, the decision was made to proceed with surgical management to ascertain the extent of necrosis. Following a partial gastrectomy, the patient had an uneventful postoperative course and met feeding milestones. Given the high morbidity rate of emphysematous gastritis and the success of our intervention, we propose the utilization of exploratory laparoscopy/laparotomy in patients with identified or highly suspected gastric ischemia. This aids in the characterization of ischemia and guides decision-making on the extent of gastric resection (partial versus complete gastrectomy).

Ehrlichiosis in a Recent Liver Transplant Recipient Leading to Multiorgan Failure.

Ehrlichia infection has a broad spectrum of diseases ranging from asymptomatic to fatal. While Ehrlichia often presents as a mild form of the disease in immunocompetent patients, immunosuppressed patients are at increased risk for a more virulent and potentially fatal infection. Our liver transplant patient presented with fever, persistent headaches, and negative Ehrlichia antibodies. Empiric antibiotic therapy was started and along with knowledge of prior tick infection, doxycycline was added. Subsequent positive PCR and observation of Ehrlichia chaffeensis in peripheral blood smear confirmed the diagnosis. The patient did recover from infection but not before it manifested in hepatic, renal, and pulmonary involvement. Therefore, a high level of suspicion is necessary for early detection and treatment initiation to prevent a devastating progression of the disease in immunosuppressed patients.

Successful Utilization of Levodopa in HIV-Induced Parkinsonism.

We report a case of a 63-year-old African American female patient with a past medical history of treatment naïve human immunodeficiency virus (HIV). She was referred to our hospital with altered mental status and rigidity with a history of progressive ambulation difficulties and decreased verbal output over the previous months as reported by her son. Her clinical presentation and brain MRI were consistent with HIV encephalopathy with bilateral basal ganglia involvement and HIV-induced parkinsonism. We initiated a trial of carbidopa/levodopa along with highly active antiretroviral therapy (HAART) (emtricitabine-tenofovir and dolutegravir). In the following three weeks, she demonstrated dramatic improvement, both clinically and radiologically. She tolerated carbidopa/levodopa well with no behavioral or neurological side effects. This case illustrates the safe utilization of carbidopa/levodopa in treating parkinsonism in an adult female patient with HIV encephalopathy.