High-Grade Mucinous Adenocarcinoma of the Appendix With Signet Features and Omental Metastasis.

Primary adenocarcinoma of the appendix is an uncommon malignancy of the gastrointestinal tract. The most common symptom is right lower abdominal pain, which could be indistinguishable from acute appendicitis. However, the clinical presentation is usually non-specific. In this present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with omental metastases in an 81-year-old male who underwent laparoscopic appendectomy. He then received palliative systemic chemotherapy using a combination of Capecitabine and Bevacizumab.

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 Pancreatitis Secondary to Newly Diagnosed Intraductal Papillary Mucinous Neoplasm.

Acute pancreatitis (AP) is a common gastrointestinal cause of hospital admissions and is prevalent in the United States. AP etiologies include alcohol use, cholelithiasis, hypertriglyceridemia, hypercalcemia, autoimmune phenomena, medications, or idiopathic. Rarely, intraductal papillary mucinous neoplasms can cause AP, as we present in this case report.

Boerhaave Syndrome: An Unexpected Complication of Diabetic Ketoacidosis.

Boerhaave syndrome (BS) is a rare gastrointestinal condition related to esophageal rupture that carries a high mortality rate without prompt medical attention. BS is commonly associated with repeated episodes of severe retching, straining, or vomiting. Diabetic ketoacidosis (DKA), a serious acute complication of diabetes, is characterized in part by laboratory findings of profound hyperglycemia and ketoacidosis. Clinically, nausea and vomiting are seen commonly in DKA patients, which can often include repeated forceful retching, but rarely associated with esophageal rupture. In this article, we will describe a case of BS secondary to repeated episodes of emesis in the setting of DKA.

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.

Recurrent Staphylococcus capitis Prosthetic Valve Endocarditis Presenting With ST-Segment Elevation Myocardial Infarction: A Case Report.

We report a case of ST-elevation myocardial infarction (STEMI) due to septic emboli secondary to Staphylococcus capitis endocarditis in a 32-year-old male patient with a past medical history of infectious endocarditis requiring mechanical aortic, mitral and tricuspid valve replacement presented with sharp chest pain and shortness of breath. Electrocardiogram demonstrated an acute inferior STEMI. Coronary angiography revealed occlusion of the terminal left anterior descending (LAD) artery associated with a large apical wrap-around segment exhibiting TIMI 0 flow. Primary angioplasty was not performed given the distal location of the embolus. Clinical suspicion for septic or thrombotic coronary artery embolism was high given the patient's history of mechanical valve prosthesis and in the setting of sub-therapeutic INR. Transesophageal echocardiography revealed a new mobile echodensity on the mitral prosthesis consistent with vegetation. S. capitis was isolated from blood cultures, confirming the diagnosis of endocarditis. S. capitis is a rare cause of prosthetic valve endocarditis and should remain in the differential of septic coronary artery embolism among patients with features of infectious endocarditis.

Primary Pancreatic Lymphoma: An Uncommon Presentation in the Pancreatic Tail.

Primary pancreatic lymphoma is a rare form of pancreatic cancer that represents a diagnostic and therapeutic challenge due to its rarity and presentation mimicking pancreatic adenocarcinoma. Herein, we report a case of a 57-year-old Caucasian male who presented with left-sided chest pain, epigastric pain, and melena. Abdominal imaging was remarkable for a large, necrotic mass near the tail of the pancreas extending into the splenic hilum and left kidney. Biopsy of the mass confirmed lymphoma of B-cell origin. The patient was diagnosed with Stage IV disease and started on chemotherapy. This case combines an uncommon presentation of lymphoma with a rarely documented primary site in the tail of the pancreas.

Anterior Cervical Corpectomy and Fusion Versus Anterior Cervical Discectomy and Fusion for Treatment of Multilevel Cervical Spondylotic Myelopathy: Insights from a National Registry.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is the most common procedure for single-level cervical spondylotic myelopathy (CSM); however, for multilevel CSM, some patients may also undergo anterior cervical corpectomy and fusion (ACCF). We sought to assess differences in clinical outcomes between patients undergoing ACDF and those undergoing ACCF for multilevel CSM. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2017 to identify patients diagnosed with CSM undergoing 1- or 2-level ACCF and 2- or 3-level ACDF. Three-to-one propensity scoring was used to match patients undergoing 1-level ACCF to those undergoing 2-level ACDF. Multivariable regression was performed to compare 30-day clinical outcomes between ACCF and ACDF recipients. RESULTS: A total of 3708 patients undergoing 1-level ACCF (n = 729; 18.7%) or 2-level ACDF (n = 3179; 81.3%) were identified. On multivariable regression, 1-level ACCF was associated with significantly longer length of stay (coefficient, 0.79; 95% confidence interval [CI], 0.46-1.11; P < 0.001), longer operative time (coefficient, 19.01; 95% CI, 11.94-26.08; P < 0.001), decreased odds of readmissions (odds ratio [OR], 0.95; 95% CI, 0.91-0.99; P = 0.018), and increased odds of complications (OR, 1.02; 95% CI, 1.00-1.04; P = 0.028) compared with those undergoing 2-level ACDF. A total of 939 patients undergoing either 2-level ACCF (n = 348; 37.1%) or 3-level ACDF (n = 591; 62.9%) were identified. On multivariable regression, 2-level ACCF was associated with significantly longer length of stay (coefficient, 1.17; 95% CI, 0.55-1.79; P < 0.001) and increased risk of complications (OR, 1.05; 95% CI, 1.01-1.08; P = 0.004) compared with 3-level ACDF. CONCLUSIONS: Our analyses indicate that ACCF may be associated with worse clinical outcomes than ACDF following multilevel treatment for CSM.

Simultaneous parotitis and ipsilateral herpes zoster ophthalmicus: coincidence?

A 43-year-old previously healthy man presented to the primary care clinic with concurrent ipsilateral viral parotitis and herpes zoster ophthalmicus. The patient experienced painful swelling below the right ear as well as painful vesicles on the right forehead, eyelid and cheek in the V1 dermatomal region. There were no lesions in the oral cavity or nose. Antibody titres confirmed active varicella zoster virus in the absence of mumps or herpes simplex virus 1 and 2 and unilateral parotitis were confirmed to be non-suppurative by the patient's primary care physician and the neurologist. Both conditions resolved within 3 weeks with appropriate treatment.