COVID-19 Presenting As Miller Fisher Syndrome in a Patient With a History of Guillain-Barré Syndrome: A Case Report.

Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, primarily affects the respiratory system. While coronaviruses are not a common cause of neurological disease, they have been reported to cause direct central nervous system infection, as well as presumed para-infectious disorders. Here we report a very rare case of SARS-CoV-2 infection presenting as Miller Fisher syndrome with positive anti-GQ1b antibodies in a patient with a history of Guillain-Barré syndrome, which was treated with IV immunoglobulin resulting in marked improvement in her symptoms. Thus, a high index of suspicion and meticulous observation are the cornerstones to identifying possible uncommon presentations of COVID-19.

Recurrent Dysphagia Associated with Esophageal Intramural Pseudodiverticulosis.

Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder of the esophagus characterized by the presence of outpouching flask-shaped lesions. These lesions represent false lumens that may be scattered throughout the esophageal wall. We present a rare case of EIPD complicated with esophageal strictures. The case is unique because the small lesions of EIPD remained undiagnosed for many years on prior esophagogastroduodenoscopy examinations until complicated with worsening symptoms of dysphagia due to esophageal stricture. The patient was managed with serial dilations of esophageal stricture. Diagnosing these lesions may be missed in early stages as the lesions are small and may require other radiological modalities to confirm the diagnosis. EIPD lesions itself can be managed conservatively with anti-inflammatory therapy and treatment of underlying risk factors. Those with severe disease and coexisting complications are managed with endoscopic or surgical interventions.

Black esophagus: a syndrome of acute esophageal necrosis associated with active alcohol drinking.

Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival.

Mycophenolate-induced Colitis: A Case Report with Focused Review of Literature.

Mycophenolate mofetil (MMF) is an immunosuppressive medication used for the management of various autoimmune diseases, and patients with bone marrow and solid organ transplants. Gastrointestinal side effects are seen 45% of the time and they include nausea (29%), vomiting (23%), constipation (38%), diarrhea (50%-92%), and colitis (9%). In 98% of cases, resolution of diarrhea occurs within 20 days upon discontinuation of the MMF. Data is scarce regarding approach in the treatment of MMF-induced colitis. We report a case of MMF-induced colitis diagnosed by colonoscopy and histopathology. This case illustrates the challenges encountered while managing MMF-induced colitis.

Acute Pancreatitis in Pancreas Divisum Secondary to an Impacted Stone in the Minor Papilla.

Pancreas divisum is reported to occur in up to 14% of the population. The majority of patients with this congenital anomaly remain asymptomatic. Pancreas divisum can be associated with recurrent pancreatitis due to inadequate drainage of pancreatic secretions through the dorsal pancreatic duct and the minor papilla. We present a patient with a six-month history of recurrent acute pancreatitis due to an impacted pancreatic duct stone in the minor papilla and an unrecognized pancreas divisum. This situation has only been reported in two other cases in the literature.

Bilateral Renal Infarction Secondary to Hypertrophic Cardiomyopathy.

Bilateral renal infarction is a rare phenomenon which can be difficult to diagnose because the symptoms may often mimic renal calculi, infection, muscle inflammation, genital diseases, myocardial infarction, or ischemia. We present the case of a 55-year-old male patient who presented with non-radiating, left-sided flank pain associated with nausea and vomiting. A computed tomography (CT) scan of the abdomen and pelvis with contrast demonstrated bilateral renal infarction. A thorough workup was initiated, and the thrombus formation due to left atrial enlargement from hypertrophic obstructive cardiomyopathy was considered as the cause of the bilateral renal infarction in this patient. The patient's renal function improved with treatment, and she was discharged on an anticoagulant, considering her left atrial enlargement and renal infarction.

Rectal Cancer in the Eye: A Case Report of Orbital Metastasis.

Orbital metastasis from colorectal cancer is extremely rare. In this case report, we describe a 48-year-old woman who presented with recurrent severe headaches and new onset constipation with no known history of cancer. After vigilant workup, imaging, and biopsies, she was diagnosed with orbital metastasis from a primary rectal carcinoma. She was started on chemotherapy and radiation therapy. Her chemotherapy regimen consisted of FLOX (leucovorin + fluorouracil + oxaliplatin), along with panitumumab, which she tolerated well. She received chemotherapy for seven months before she lost her battle with cancer.