Hawai'i's First Published Case of Eggerthella lenta Sepsis.

Human bacteremia with Eggerthella lenta is rare. Upon review of the literature, the largest case series includes only about 100 cases, and optimal management of the condition is still unclear. This case report describes a patient diagnosed with E. lenta septicemia due to acute diverticulitis in 2019. This is the first published report of sepsis caused by E. lenta in the state of Hawai'i.

A Serendipitous Find: A Case of Cholangiocarcinoma Identified Incidentally After Acute Liver Injury Due to Cascara sagrada Ingestion.

The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice, clay-colored stools, and darkening urine can mimic the presentation of a variety of hepatobiliary illnesses, including cholangiocarcinoma. This case report describes a local patient diagnosed with an extrahepatic cholangiocarcinoma following workup for an acute hepatitis due to ingestion of large quantities of Cascara sagrada.

Emergence of Raoultella ornithinolytica on O'ahu: a case of community-acquired R. ornithinolytica urinary tract infection.

Human infection with Raoultella ornithinolytica is rare, with only ten cases having been reported previously. This case report describes a local patient diagnosed with community-acquired R. ornithinolytica urinary tract infection in 2014.

Group B streptococcal (GBS) bacteremia with mycotic thoracic aortic aneurysm and suppurative pericardial effusion.

Mycotic aortic aneurysm associated with suppurative pericardial effusion is a rare and serious clinical phenomenon that is linked with significant morbidity and mortality. We report a case of a 78-year-old man who presented with purulent pericardial effusion with tamponade physiology in association with a progressively enlarging, transverse aortic arch, mycotic aneurysm due to group B streptococci. To our knowledge, this is only the second reported case of this nature. Despite advances in the current era of antibiotics and surgical techniques, early diagnosis and aggressive treatment remain sentinel to successful management of the cardiovascular complications of group B streptococcus bacteremia.

Emergence of Burkholderia cepacia in Honolulu: a case of nursing home-acquired B. cepacia sepsis.

Burkholderia cepacia has rarely been reported in Honolulu. Its emergence as a nursing home-acquired pathogen with high mortality rate is concerning. This case report describes a local nursing home patient who was diagnosed with B. cepacia sepsis in 2012.

Emergence of community-acquired extended-spectrum beta-lactamase Escherichia coli (ESBLEC) in Honolulu: a case series of three individuals with community-acquired ESBLEC bacteriuria.

Community-acquired extended-spectrum beta-lactamase E coli (ESBLEC) have not been previously described in Honolulu. Its emergence as a community-acquired pathogen is concerning. This case series describes three patients who were diagnosed with community-acquired ESBLEC bacteriuria in 2010.

Laugh syncope as a rare sub-type of the situational syncopes: a case report.

INTRODUCTION: Laughter is a good medicine; it enhances cardiovascular health and the immune system. What happens, however, if a person laughs too much or the laughter becomes out of control? Laughter-induced syncope is rare and likely goes unrecognized by many health care providers. It is thought to be another form of Valsalva-induced syncope. CASE PRESENTATION: We report the case of a 56-year-old, moderately obese (body mass index of 35) man with a past medical history of sleep apnea, hypertension and hyperlipidemia who suffered from syncope secondary to intense laughter. The patient also had a history of syncope in the distant past when he collapsed on the floor for several seconds. Treadmill stress testing after the incident revealed no arrhythmia or ischemic disease, although he complained of dizziness after the test and a sudden drop in blood pressure was noted. CONCLUSION: Laughter-induced or gelastic syncope is extremely rare. It is thought to be a sub-type of the situational syncopes.

A classic case of ITP in a woman presenting with spontaneous bruising.

Idiopathic thrombocytopenic purpura is an autoimmune disorder causing thrombocytopenia. The authors present the case of a patient who presented with spontaneous bruising. A complete blood cell count revealed the patient was severely thrombocytopenic with a platelet count of 4000. Further evaluation failed to reveal a cause for thrombocytopenia and the patient was subsequently diagnosed with idiopathic thrombocytopenic purpura.

A rare case of a pancreatic tumor in association with the syndrome of inappropriate antidiuretic hormone secretion.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a well-known complication in malignancy, especially small cell carcinoma of the lung. However its association with pancreatic carcinoma is rare. To the best of our knowledge, only 9 cases have been reported in the literature. We present the case of a 90 year-old woman with pancreatic carcinoma who developed SIADH.

Synchronous liver cancers: A rare tumor combination in an elderly Japanese woman.

Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) may occur simultaneously in a person with primary liver cancer However HCC and CC arising from separate foci is extremely rare. This is a case presentation of a 66-year-old woman with primary combined HCC-CC, who had no risk factors for either tumor.

Severe hemorrhagic complication of talc pleurodesis for idiopathic pleural effusion.

Talc is a commonly used sclerosing agent for pleurodesis. However, there have been recent reports of a number of complications associated with the use of talc. Although there is significant data regarding the respiratory complications associated with talc, reports of bleeding complications are extremely rare. We present the case of a 78 year-old man who was treated with talc pleurodesis for recurrent pleural effusion and subsequently developed a massive hemothorax, a rare complication.

Acute generalized pustular psoriasis presenting with erythroderma associated with shock and acute renal failure.

Acute generalized pustular psoriasis is an uncommon but dangerous form of psoriasis with a systemic presentation. Acute exacerbation, an early picture of acute generalized pustular psoriasis (AGPP), can be fatal, therefore, early recognition and systemic therapy is critical. It is an important differential diagnosis of erythroderma. Epidemiology, etiology, diagnosis, and treatment options are discussed in this paper.

Chylothorax and cirrhosis of the liver: a case report.

Chylothorax occurring in the setting of a lymphoma or a surgical procedure involving the area around the thoracic duct is a well-known phenomenon. Less common is the occurrence of chylothorax in conjunction with cirrhosis of the liver. Due to the paucity of data, it is uncertain if chylothorax is an associated or an independent sign of cirrhosis. The case reports in the literature favor the former, as demonstrated in this case of a patient with cirrhosis of the liver who developed a chylothorax.

Hyponatremia associated with sertraline and fluoxetine: a case report.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare but serious adverse effect of the selective serotonin reuptake inhibitors (SSRIs). Although many case reports describe this association, few report the effect of rechallenge with another SSRI. We present a case of an elderly patient who developed hyponatremia with sertraline and SIADH when rechallenged with fluoxetine.

Therapy with hypertonic saline in combination with anti-convulsants for hyponatremia-induced seizure: a case report and review of the literature.

Seizures are an uncommon but serious complication of hyponatremia which can lead to permanent brain damage and even death. It is recommended that patients with hyponatremic-induced seizures be treated with 3% hypertonic saline, however, a rapid rate of correction may result in central pontine myelinolysis (CPM), a severe neurological disorder characterized by mutism, dysarthria, spastic quadriparesis, and pseudobulbar palsy. The patient in this case developed a hyponatremia-induced generalized tonic-clonic seizure which was aborted by rapid therapy with diazepam, followed by hypertonic saline and phenytoin. Subsequent replacement of hypertonic saline with normal saline and salt tabs in combination with phenytoin allowed gradual correction of serum sodium without any subsequent seizures or neurological complications.