Medication-Induced Factor V Inhibition in the Setting of Refractory Coagulopathy.

Liver cirrhosis is commonly associated with coagulopathies, typically demonstrated by elevated prothrombin time, international normalized ratio, and partial thromboplastin time. In the setting of bleeding related to coagulopathies, oftentimes physicians try to reverse coagulopathy through a variety of methods including the use of vitamin K and fresh frozen plasma. Rarely, attempts at reversing coagulopathy are unsuccessful due to severe disease or factor inhibitors. The treatment of acquired factor V inhibitors is primarily performed through immunosuppression and supportive care for the initial bleeding episode. Early detection and treatment of factor V inhibition is challenging in a setting of underlying cirrhosis-related coagulopathy.

Myxedema Secondary to Levothyroxine Malabsorption in Newly Diagnosed Celiac Disease.

Celiac disease (CD) is an autoimmune disorder that predominantly affects the small intestine and is related to antibodies created against gluten when the substance is ingested. It is uncommon comorbidity in patients with Hashimoto's thyroiditis (HT). Myxedema is a severe form of hypothyroidism that is commonly related to new diagnoses, medication non-compliance, or malabsorption of thyroid supplementation that can have life-threatening associated conditions like heart failure and coma. In this article, we will describe a case of myxedema secondary to levothyroxine malabsorption in the setting of a newly diagnosed CD.

Acute Renal Failure and Nephrotic Syndrome Secondary to Collapsing Glomerulopathy Associated With Hepatitis C.

Collapsing glomerulopathy (CG) is a rare variant of focal segmental glomerulosclerosis (FSGS) that commonly presents as nephrotic syndrome in patients. CG is almost always associated with human immunodeficiency virus (HIV) infection but is rarely from other infectious sources such as parvovirus, Epstein-Barr virus, cytomegalovirus, and SARS-CoV-2. CG has also been reported to be related to other etiologies such as genetic disorders, lupus, malignancy, and post-renal transplant but is exceedingly rare when related to hepatitis C virus (HCV). In this report, we describe the case of a patient presenting with nephrotic syndrome secondary to CG caused by newly diagnosed HCV.

Splenic Injury After a Colonoscopy: Threading the Scope Carefully in Heritable Connective Tissue Disorders.

Colonoscopies have reduced colorectal cancer (CRC) burden in the United States, and their utility has expanded to include various diagnostic and therapeutic indications. Complications are seen in up to 1% and increase with age and polypectomy. As colonoscopies become widespread, specific populations seem to be at a much higher risk; notably patients with heritable connective tissue disorders (HCTD). As life expectancy increases, these patients undergo routine screenings and require careful peri-endoscopic care to reduce adverse outcomes. Amongst HCTD, Ehlers-Danlos syndrome (EDS) is commonly implicated, however, no reports of Marfan syndrome (MS) exist. We present a unique case of splenic injury after colonoscopy in a patient with MS. Successful outcomes require early suspicion and emergent surgical evaluation in patients with hemodynamic instability after a colonoscopy. Increased ligament laxity and bowel fragility are the most likely mechanisms. Alternative CRC strategies like fecal immunochemical test (FIT), fecal occult, Cologuard, or virtual colonography can be considered.

Balsalazide-Induced Pneumonitis Causing Dyspnea in a Patient With Inflammatory Bowel Disease.

Inflammatory bowel disease complications can be related to inflammatory bowel disease-related pulmonary diseases or a form of hypersensitivity pneumonitis secondary to the immunosuppressive medications. We present a patient with intermittent chest pain and hypoxic respiratory failure who was found to have balsalazide-induced pneumonitis. We discuss the treatment and long-term outlook.