Radiation-Induced Peripheral Artery Disease in a 63-Year-Old Patient.

Tobacco use, hypertension, diabetes, and hypercholesterolemia are known risk factors for peripheral artery disease (PAD). However, additional causes of PAD, such as radiation therapy, should be considered for the prevention and diagnosis of this disease. The patient described in this report had 36 radiation therapies directly to the pelvis and bladder area due to bladder cancer. The presence of severe PAD on this patient's right external iliac artery, the same area where he received radiation therapy, raises the question of whether radiation therapy contributed to the development of PAD. In addition, his history of anal intraepithelial neoplasia, obstructive uropathy, and chronic kidney disease further demonstrated that he possibly suffered extensive tissue damage due to radiation to the pelvis. This case report explores the current diagnosis guidelines and treatment options for patients with radiation-induced PAD. Through this case study, we aim to bring awareness to this lesser-known cause of PAD among medical providers and promote research for the prevention and treatment of this disease.

An Incidental Finding of a Glucagon-Like Peptide 1 (GLP-1)-Induced Acute Kidney Injury: A Case Report.

Acute kidney injury (AKI) involves a rapid decline in kidney function, classified into prerenal, intrarenal, and postrenal causes. Drug-induced AKI's complex pathophysiology includes altered hemodynamics, inflammation, crystal deposition, hemolysis, and rhabdomyolysis. This report details a 42-year-old female with hypertension and diabetes who, following a dog bite, exhibited reduced kidney function (GFR: 16 ​​mL/min/1.73m2; BUN/Cr: 23/3.23 mg/dL). A renal ultrasound revealed no stones or masses, and the recent use of tirzepatide was identified. Discontinuation of the drug, IV fluid maintenance, and close monitoring led to swift kidney function improvement. This case underscores the importance of recognizing drug-induced AKI, even in unrelated complaints, and highlights the need for vigilance and research into the adverse effects of medications such as glucagon-like peptide 1 (GLP-1) receptor agonists.

Acute Cholecystitis Presenting With Atypical Radiologic or Laboratory Findings: A Case Report.

Acute cholecystitis is the most common presentation of gallbladder (GB) disease. It has an incidence of around 200,000 cases a year in the United States (US) and affects approximately 20 million individuals in the US. In most cases, it presents with a history of symptomatic gallstones. Initial management includes intravenous hydration and antibiotics, bowel rest, and analgesia. Complicated cases are typically resolved with surgery (laparoscopic cholecystectomy). The pathogenesis of acute cholecystitis is most often explained by obstruction of the cystic duct. Research has shown that there are more contributing factors than just obstruction alone. We present a case of a 38-year-old Hispanic woman who came to our emergency department with a chief complaint of the anterior chest wall and epigastric pain. Physical examination was remarkable for epigastric tenderness and negative Murphy's sign. She had no fever. Cardiac troponins and electrocardiogram (EKG) were negative. Initial labs showed no sign of infection with white blood cell (WBC) count within the normal range, and only mildly elevated aspartate aminotransferase (AST), alanine transaminase (ALT), and total bilirubin. Follow-up abdominal computerized tomography (CT) scan without contrast and right upper quadrant (RUQ) abdominal ultrasound showed cholelithiasis without evidence of cholecystitis. An hepatobiliary iminodiacetic acid (HIDA) scan on day three of admission revealed an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy with an intraoperative cholangiogram. The surgery was uneventful; it was remarkable for a very distended, inflamed, and edematous GB, which had to be decompressed with a lap needle for removal. It is evident that acute cholecystitis may not always present with the classic diagnostic criteria, including laboratory results (leukocytosis, elevated C-reactive protein) and physical exam findings (fever, RUQ pain, and + Murphy's sign). However, a thorough work-up can be just as effective in diagnosis.

Flesh Fly Maggot-Infected Abscess in a Burn Victim Patient in the United States Without a History of International Travel: A Case Report.

This case report describes an uncommon occurrence of myiasis, specifically a maggot-infected abscess, in a patient with reduced skin sensitivity resulting from severe burns. Myiasis is the infestation of live animal tissue by fly larvae, and while it is primarily associated with tropical and subtropical regions, cases acquired within the United States are rare. The presented case involves a 70-year-old male who arrived at the emergency department with an intensely painful, non-healing wound in the left elbow. Upon examination, the wound was found to be infested with numerous live maggots, and subsequent investigations revealed the larvae to be of the flesh fly species (Sarcophagidae). The patient's history of reduced skin sensitivity, previous burn injuries, and exposure to outdoor environments, coupled with poor hygiene and homelessness, likely contributed to the infestation. This report emphasizes the importance of considering myiasis caused by flesh fly larvae even in non-travel-related cases within the United States. Early recognition and prompt treatment are vital to preventing complications and secondary infections. Healthcare providers should remain vigilant in identifying and managing myiasis, and patients with decreased skin sensation should be educated about the need for regular skin surveillance and the utilization of preventive measures to mitigate potential infestations.