ABSTRACT
Many opportunistic infections (OIs) seen early in the human immunodeficiency virus (HIV) epidemic receded in prevalence with the advent of antiretroviral therapy (ART). Despite the availability of early detection and treatment of HIV as well as guidelines for near-universal screening, there remains a sizable population of individuals living with HIV who are not yet aware of their HIV status. These individuals are at risk for OIs such as toxoplasmosis, which would otherwise be preventable with ART and appropriate prophylaxis. Toxoplasmic encephalitis (TE) usually occurs in the late stages of HIV with acquired immunodeficiency syndrome (AIDS), but we present a case of a 38-year-old female with TE as the initial presentation of HIV/AIDS. Testing for the presence of an immunocompromising condition such as HIV is important in patients presenting with focal brain lesions as the differential diagnosis will change, and proper workup may spare invasive procedures such as a brain biopsy.
ABSTRACT
Moyamoya disease is a cerebrovascular disease characterized by stenosis of large intracranial arteries and the development of smaller collateral vessels. Moyamoya may cause strokes and stroke-like symptoms in young patients. It has also been linked to autoimmune diseases and neuropsychiatric conditions. We present a case of moyamoya disease in a young patient with concomitant hyperaldosteronism, uncontrolled hypertension, and cocaine use disorder, along with features of antisocial personality disorder. This is a unique presentation of an underlying neurological disease causing psychiatric features exacerbated by cocaine use, and it describes a rare clinical presentation that physicians should consider in patients with moyamoya disease.
ABSTRACT
Diaphragmatic hernias (DH) may be congenital or acquired in origin. Those causing obstructive jaundice in the elderly are extremely rare but can occur. These patients may present with painless jaundice, early satiety, and weight loss due to biliary tract obstruction and stomach compression by the hernia. Therefore, clinicians should consider an anatomic anomaly when evaluating patients with jaundice. Here, we report the case of a 71-year-old female, with a medical history of hypertension and chronic obstructive pulmonary disease, who presented with jaundice. The patient was found to have dilation of the common bile duct due to external mechanical compression of abdominal organs from a DH. Because the patient had poor functional status and multiple comorbidities, the risks of surgically correcting the hernia outweighed the benefits. The patient instead received a biliary decompression and stent, and her jaundice significantly improved.
