RÉSUMÉ
Infective endocarditis (IE) can present with a variety of signs and symptoms, including skin lesions. The few papers describing a relationship between IE and vasculitis are split between IE being able to mimic vasculitis and between IE indeed being associated with a vasculitis involving the skin, kidney, gastrointestinal tract, or peripheral nerves. It is important for clinicians to distinguish between an isolated vasculitis, infective endocarditis, and IE-associated vasculitis because the treatments and outcomes are different. We report a case of a patient with a history of intravenous (IV) drug use who initially presented with chest pain, was started on vancomycin following diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) IE, left against medical advice (AMA), and then returned to the hospital due to development of a purpuric rash. We contend that while he did not have a skin biopsy due to time delay, his symmetrically distributed purpura was consistent with cutaneous vasculitis. His symptoms, including his rash and an acute kidney injury (AKI), improved with antibiotics to treat the endocarditis.
RÉSUMÉ
Small cell neuroendocrine carcinoma (SNEC) is a high grade and poorly differentiated neuroendocrine tumor which typically presents as a primary pulmonary neoplasm near the bronchial region. Due to the aggressive nature of the tumor, there are many ways it can initially present, mostly involving the lungs. We present a case of a 68-year-old male patient who initially presented with new-onset of severe thrombocytopenia with superimposed pneumonia. It was late in the progression of the disease that histopathology from the bone marrow confirmed SNEC, which presented only after it metastasized to the bone marrow by way of a rare paraneoplastic syndrome. Furthermore, the bone marrow biopsy revealed atypical markers not commonly seen in SNEC. Since this was such an atypical presentation of SNEC, management was limited to stabilization of the patient. The patient expired two weeks later.