Acute Disseminated Encephalomyelitis Associated With Chronic Cannabis Abuse.

Acute disseminated encephalomyelitis (ADEM) is a rare monophasic immune-mediated inflammatory disorder characterized by multifocal demyelinating lesions of the central nervous system. Clinically, it is distinguished by a variety of acute neurological deficits, including varying degrees of mental state changes and white matter abnormalities detected by magnetic resonance imaging (MRI). We present a challenging case of a young woman who developed ADEM as a result of chronic cannabis abuse. This, to the best of our knowledge, is the second case report of ADEM linked to cannabis abuse.

Hemorrhagic Pleural Effusion: A Rare Presentation of Vitamin K Deficiency in an Adult Patient.

Nutritionally acquired vitamin K deficiency is a rare condition in adults and can uncommonly present as hemorrhagic pleural effusion. We discuss the case of A 44-year-old apparently healthy man who presented with left-sided pleuritic chest pain two months after experiencing upper respiratory tract symptoms. Imaging revealed a loculated left-sided effusion, and a corresponding thoracentesis yielded exudative hemorrhagic fluid with no microbial growth. Laboratory work-up showed prolonged clotting time with low factors II, VII, and X activity, absence of clotting factor inhibitors, and very low serum vitamin K levels. A five-day course of oral vitamin K and nutritional optimization normalized the clotting profile. Acquired vitamin K deficiency from poor micronutrient intake is rare in adults and can result in hemorrhagic pleural effusion. Vitamin K supplementation can normalize the clotting profile while nutritional counseling helps prevent a recurrence. Malnutrition-induced vitamin K deficiency can occur in the setting of a major depressive disorder in adults. Thorough patient history and physical examination are necessary to promptly identify and reverse the coagulopathy.

Hypertrophic pulmonary osteoarthropathy: an unusual presentation.

OBJECTIVES: Hypertrophic pulmonary osteoarthropathy (HPOA) is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs. HPOA without clubbing of the digits is considered an incomplete form of HPOA and has been rarely reported. We are presenting here a case of HPOA without clubbing in a patient with lung cancer. METHODS: A 52-year-old female active smoker presented with a complaint of multiple joint pains with associated morning stiffness, swelling and weight loss for 3 months. On examination, the patient had tenderness to palpation over the anterior shin, but no obvious clubbing was noted. X-rays of the lower extremities revealed periosteal thickening compatible with HPOA. RESULTS: A bone scan showed increased uptake along the periosteum and cortex of the long bones. In view of her smoking history and weight loss, a chest X-ray was done that revealed an upper lung mass. A diagnosis of lung carcinoma was made on biopsy. CONCLUSION: Our case demonstrates that the unusual finding of HPOA in the absence of clubbing is a rare entity and can often be missed. Once diagnosed, a prompt search of other associated conditions should be conducted.