Clinically amyopathic dermatomyositis associated with anti-MDA5 antibody.

Clinically amyopathic dermatomyositis (CADM) is a rare entity that presents with cutaneous manifestations of classic dermatomyositis but without muscle weakness or abnormal muscle enzymes. It is more common in young white and Asian females. A subset of patients with CADM has a specific antibody known as anti-MDA5. These patients have a more aggressive course with distinct cutaneous features, pulmonary involvement and early death. Here, we present the case of a 64-year-old Caucasian male with no significant medical history who was admitted with marked weight loss and a painful rash for 6 months. Patient had no muscle weakness and his rash was characteristic of classic dermatomyositis. Skin biopsy was suggestive of dermatomyositis but muscle enzymes were normal. His serum was positive for anti-MDA5 antibody. Extensive workup failed to detect any malignancy but he did show non-specific interstitial pneumonia. He was treated with prednisone and mycophenolate with good clinical response.

A rare case of primary rectal squamous cell carcinoma diagnosed by endoscopic ultrasound.

Primary squamous cell carcinoma (SCC) of the rectum is a very rare entity making up to 0.1-0.25/1,000 cases of all colorectal cancers. Here, we present the case of an otherwise healthy 63-year-old female who presented with progressive pelvic discomfort, new onset constipation and a complex mass in presacral region on imaging which was proved to be poorly differentiated SCC of the rectum. The correct diagnosis was achieved by fine needle aspiration (FNA) via endoscopic ultrasound (EUS-guided FNA) as initial conventional colonoscopy failed to establish the diagnosis. Patient completed neoadjuvant chemo-radiation and her tumor was successfully resected. She is following up with oncology clinic for monitoring and further management.

"A Large Hiatal Hernia": Atypical Presentation of Gastric Volvulus.

Gastric volvulus is a rare condition defined as an abnormal rotation of the stomach by more than 180 degrees. Gastric volvulus could present atypically with simply nausea and vomiting. A high index of suspicion is required for prompt diagnosis and treatment, especially when a patient presents with subacute intermittent gastric volvulus. Here, we present the case of a 56-year-old female with lung cancer status post left lower lobectomy undergoing chemotherapy who presented with intermittent nausea and upper abdominal pain for a few weeks. Barium study and computed tomography revealed acute mesenteroaxial gastric volvulus and she was treated with urgent surgical intervention.

A rare localised nasal CD30+ primary cutaneous T-cell lymphoma following liver transplantation.

Cutaneous T-cell post-transplant lymphoproliferative disorder (PTLD) is a rare clinical presentation that can potentially turn aggressive in solid-organ transplant recipients if not detected and intervened on early. We encountered a rare case of rapidly worsening primary cutaneous CD30-positive, Epstein-Barr virus-negative anaplastic large cell lymphoma (ALCL) of T-cell origin, manifesting as an isolated nasal tip lesion in a 71-year-old man 4 years after orthotopic liver transplantation. Excisional biopsy with partial rhinectomy showed subepithelial diffuse infiltration of medium-to-large lymphoid cells having round-to-irregular nuclei, partially condensed chromatin and prominent nucleoli. Immunophenotypic studies revealed CD30-positive primary cutaneous ALCL. Positron emission tomography/CT imaging revealed a locally active disease, and radiation therapy was initiated with complete response. A high index of suspicion for PTLD when evaluating skin lesions in a post-transplant patient is paramount for its early recognition, prompt diagnosis and timely intervention while the window for curative therapy remains possible.

Lithium chloride disrupts consolidation of morphine-induced conditioned place preference in male mice: the nitric oxide/cyclic GMP signaling pathway.

Lithium effects on brain functions such as cognition, attention, learning and memory are well-established for ages; however, the way it affects these functions and its precise mechanism of action remains unknown. The purpose of this study was to determine the effects of lithium on the consolidation of morphine-associated conditioned place preference and the possible involvement of the NO/cGMP pathway. Using an unbiased conditioned place preference (CPP) model, the effects of lithium (1-100 mg/kg, i.p.), nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) (5-100 mg/kg, i.p.), nitric oxide precursor L-arginine (50-150 mg/kg, i.p.) and phosphodiesterase inhibitor sildenafil (5-40 mg/kg, i.p.) on the consolidation of morphine-induced CPP were assessed. In addition, the possible interaction between lithium, L-arginine and sildenafil or subeffective doses of lithium and L-NAME on the consolidation of morphine-induced contextual memory was evaluated. NMRI mice were used in all studies. Lithium (5-30 mg/kg, i.p.), immediately after conditioning trials, significantly reduced the time spent by mice in the reward-paired compartment. Although post-training administration of L-arginine, sildenafil or L-NAME had no significant effect on the consolidation of CPP, concomitant administration of L-arginine (50-150 mg/kg) and sildenafil (5-10 mg/kg) with lithium (30 mg/kg) prevented the impairing effect of lithium. Also, co-administration of sub-effective doses of lithium (1 mg/kg) and L-NAME (5 mg/kg) disrupted consolidation of CPP. However, delayed administration of effective doses of lithium, which shows specific effect on memory consolidation, did not affect morphine-induced CPP. Lithium seems to inhibit consolidation of morphine-induced CPP and this impairing effect might be via nitric oxide/cyclic GMP pathway.