RESUMEN
This case outlines the complications of Roux-en-Y gastric bypass surgery (RYGBS) and demonstrates clinical manifestations of several vitamin deficiencies. We present a 45-year-old female patient who was admitted to our hospital with generalized weakness, anasarca, hypotension, and failure to thrive, a year after she had her RYGBS. After the procedure, she had nausea, vomiting, and diarrhea with progressive inability to tolerate any oral intake. Subsequently, the patient lost over 200 pounds and got bedridden. Initially, after the procedure, the patient had a dilatation of her anastomotic stricture, but after her surgeon moved out of town she was lost to follow up until she presented to our hospital. Upon arrival, the patient was hypotensive, tachycardic, and appeared dehydrated. The exam also revealed several clinical manifestations of vitamin deficiencies including dermatitis concerning Pellagra, follicular hyperkeratosis, and Bitot spots. Laboratory data showed significantly low albumin, protein, acute kidney injury, and several electrolyte abnormalities. The patient had to be admitted to the ICU for pressure support along with colloid and electrolyte replacement. An Esophagogastroduodenoscopy (EGD) was performed which revealed a clean-based ulcer and a 10-mm anastomotic stricture. She was started on Total Parenteral Nutrition (TPN). After the dilatation of the stricture, the patient was able to tolerate oral intake and TPN was subsequently discontinued upon discharge. The patient was educated extensively on the importance of compliance with daily vitamin supplementation and regular follow-up with bariatric physicians at discharge.
RESUMEN
Ceftaroline is a fifth-generation cephalosporin that can be used for the treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA). A rare adverse effect of ceftaroline therapy is thrombocytopenia. Our case involves a 45-year-old male with active intravenous drug usage who presented with persistent fever, lower back pain, and left elbow pain. His bloodcultures were found to be positive for MRSA. He was initially started on vancomycin; subsequently, the antibiotic was changed to daptomycin and ceftaroline, as vancomycin failed to clear the bacteremia. Seven days after initiation of ceftaroline, it was unintentionally discontinued by the electronic health record. Following its resumption two days later, the patient started having epistaxis accompanied by an acute drop in his platelet count from 422,000 cells/µL to less than 2,000 cells/µL. The ceftaroline therapy was discontinued, and he received a platelet transfusion. However, daptomycin was continued, resulting in successful resolution of his bacteremia. The patient's platelet count at discharge improved to 582,000 cells/µL. The patient was diagnosed with ceftaroline-induced thrombocytopenia, and it was added to his list of allergies.
RESUMEN
Hypercalcemia secondary to adrenal insufficiency is a rare condition, but it must be recognized and treated promptly to prevent complications such as kidney damage, bone loss, and cardiac arrhythmias. The co-occurrence of hypercalcemia and adrenal insufficiency can be seen in some rare conditions such as sarcoidosis, however, hypercalcemia as a direct consequence of adrenal insufficiency is well documented in the literature but seldom recognized and often remains underdiagnosed. Symptoms of hypercalcemia in this setting include fatigue, weakness, nausea, vomiting, constipation, abdominal pain, confusion, and dehydration. Treatment typically involves correcting the underlying adrenal insufficiency with hormone replacement therapy, along with measures to lower calcium levels in the blood, such as hydration. In this article, we report the case of a patient presenting with hypercalcemia secondary to adrenal insufficiency.
RESUMEN
Angiotensin-converting-enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARBs) are commonly used to manage hypertension and cardiovascular diseases. Although angioedema due to ACEI is a well-known side effect, only a few cases are associated with ARBs, such as losartan. Medication-induced angioedema has been known for many years; however, the mechanism by which many medications cause angioedema is not clearly understood. Here we present the case of angioedema in a 50-year-old male taking losartan after he developed acute kidney disease.
RESUMEN
Hydatid cyst of the liver is a rare zoonotic disease in the United States. It is caused by Echinococcus granulosus. This disease is mainly seen among immigrants from countries where this parasite is endemic. Differential diagnoses of such lesions can include pyogenic or amebic abscesses, in addition to other benign or malignant lesions. We report the case of a 47-year-old woman who presented with symptoms of abdominal pain and was diagnosed with a hydatid cyst of the liver masquerading as a liver abscess. Microscopic and parasitological tests confirmed this diagnosis. The patient was treated and discharged without further complications during follow-up.
RESUMEN
Fibrillary glomerulonephritis is a rare condition characterized by glomerular accumulation of non-branching fibrils, leading to hematuria, proteinuria, and hypertension. It is often associated with malignancy but has no known cause. A 66-year-old Caucasian female with a history of vulvar squamous cell carcinoma presented with one month of painless hematuria in the setting of new-onset progressive renal dysfunction and nephrotic range proteinuria. Comprehensive evaluation, including renal biopsy with staining for DnaJ heat shock protein family member B9 (DNAJB9), provided a definitive diagnosis of fibrillary glomerulonephritis. The patient initially received rituximab and prednisone therapy. Unfortunately, her renal function continued to decline over the next month, requiring re-hospitalization with initiation of hemodialysis. To our knowledge, this is the first case describing an association between vulvar squamous cell carcinoma and fibrillary glomerulonephritis.
RESUMEN
Ketosis-prone type 2 diabetes is a form of diabetes that usually presents with diabetic ketoacidosis (DKA) in patients who are not insulin dependent. It is commonly seen in African, African American, and Hispanic populations. Although the pathogenesis is not fully understood yet, it is believed to be caused by stress-induced reversible beta-cell and alpha-cell dysfunction in the pancreas. Here, we describe the case of an 80-year-old white female with well-controlled type 2 diabetes mellitus who had unexplained DKA in the setting of a urinary tract infection. The patient's DKA resolved after administering appropriate therapy, and she did not require treatment with insulin on discharge.
