Oral Dyskinesia in a Pediatric Patient Following Concurrent Use of Neuroleptics and Stimulants: Treatment Strategy Considerations to Avert Avoidable Adverse Side Effects.

Withdrawal-emergent dyskinesia is a movement disorder that emerges following sudden discontinuation or rapid taper of antipsychotic medication. It is infrequently identified and typically resolves within a few weeks from symptom onset. This case report describes a unique case of reversible oral dyskinesia in a 13-year-old male in the context of concurrent neuroleptic withdrawal and stimulant titration. The extant literature describing tardive dyskinesia is well-established; however, few studies have thoroughly examined withdrawal-emergent dyskinesia and other tardive syndromes. This report highlights the importance of clinician awareness as far as the potential for extrapyramidal symptoms and withdrawal-emergent adverse effects in concomitant management of antipsychotics and stimulants in the child and adolescent populations and may help inform future treatment and management of disorders that would indicate the concurrent use of these psychotropics.

Multi-Etiological Hyponatremia in Association With Suspected Beer Potomania.

Beer potomania is a unique condition characterized by hyponatremia secondary to excessive beer drinking and low daily solute intake. We report a case of a 41-year-old African American female with multiple comorbidities, notably alcohol use disorder, who was initially treated for hypertensive emergency and was subsequently found to be hyponatremic during the same visit. Beer potomania was suspected as a leading etiology of hyponatremia. This report emphasizes the importance of the proper diagnosis and appropriate management of beer potomania in the setting of concomitant comorbidities. Clinician awareness is crucial in implementing immediate treatment and in the prevention of potentially fatal sequelae such as severe malnutrition and osmotic demyelination syndrome.

Asymptomatic Lead Poisoning in a Pediatric Patient.

Lead poisoning is a harmful condition, potentially resulting in irreversible impairments in neurocognition and behavioral development in the pediatric population. Rarely, life-threatening complications may ensue. We report a case of an asymptomatic four-year-old patient presenting with elevated lead levels (74.7 µg/dL) detected on routine blood lead screening at a well-child examination. The patient has a history significant for atopic disease, namely atopic dermatitis, seasonal allergic rhinitis, and food allergies. Overall, the asymptomatic nature of lead poisoning warrants judicious screening in the pediatric population due to the potential for neurologic complications.

Chronic Venous Insufficiency and Lymphedema With Papillomatosis Cutis Lymphostatica, Hyperkeratosis, and Skin Ulcers: A Case Report.

Chronic venous insufficiency (CVI) is a common condition characterized by lower extremity edema, discomfort, and skin changes due to venous hypertension caused by incompetent or obstructed venous valves. We report a case of chronic venous insufficiency and lymphedema with papillomatosis cutis lymphostatica, hyperkeratosis, and skin ulcers with proteus superinfection. A 67-year-old male presented to the emergency department (ED) for wound evaluation and was found to have severe hyperkeratosis, multiple ulcers with purulent discharge, and "tree bark" skin changes. Prophylactic treatment for deep vein thrombosis (DVT) was initiated, followed by successful surgical debridement. A subsequent diagnosis of Proteus mirabilis superinfection was treated accordingly. This report highlights the importance of adequate long-term management of chronic venous insufficiency as it may lead to serious complications.

Non-strangulated Spigelian Hernia: A Case Report.

Spigelian hernia is a rare type of ventral hernia with an incidence of 0.1-2%. We report a case of a non-strangulated left lower quadrant spigelian hernia and its management. A 74-year-old female presented with progressively worsening left flank pain along with dysuria and frequency related to pyelonephritis. Incidentally, CT of the abdomen and pelvis demonstrated a left spigelian hernia containing intermediate size small bowel without strangulation. Thereafter, she began developing increasing abdominal pain in that area. The hernia was repaired on the same day as admission via laparoscopic intraperitoneal onlay mesh-plus repair. Spigelian hernia possesses an elusive clinical presentation. Though rare, it must be considered in the differential diagnosis of abdominal hernia due to its high risk for acute complications.

Pneumatosis Intestinalis, Pneumoperitoneum, and Ascites Secondary to Scleroderma: A Case Report.

Pneumatosis intestinalis (PI), pneumoperitoneum, and ascites are radiographic findings that may be incidental or associated with severe bowel compromise. Asymptomatic patients with benign PI, pneumoperitoneum, or ascites are often observed or treated conservatively. However, these findings are concerning in symptomatic patients and often require surgical consultation and urgent surgical intervention Approximately 15% of PI cases are idiopathic, and 85% are secondary due to an underlying pathology including but not limited to pulmonary disease, autoimmune disease, drug-induced sources, gastrointestinal disease, infectious sources, and iatrogenic sources. A management plan for PI proves challenging to create when the pathogenesis is poorly understood and the presenting clinical picture varies. Reported is a case of a 51-year-old female with severe abdominal pain, PI, pneumoperitoneum, and ascites. Managing a patient presenting this way with surgical intervention is a viable option; however, this patient's management was successful using a conservative approach.