Neutropenic Enterocolitis in a Metastatic Seminoma Patient With Streptococcus gallolyticus Bacteremia.

Neutropenic enterocolitis (NEC), also referred to as typhlitis, is a condition associated with a high mortality risk and primarily manifests in immunocompromised patients. It is characterized by ulceration, edema, and hemorrhage affecting the bowel wall. The underlying cause of NEC is postulated as an immunocompromised condition that facilitates bacterial infiltration through compromised bowel mucosa. The high mortality rate is attributable to bowel necrosis, culminating in perforation and sepsis. This report describes a case involving a patient with metastatic seminoma who exhibited seizure-like activity, fever, Streptococcus gallolyticus bacteremia, and NEC. The patient underwent treatment involving broad-spectrum antibiotics and filgrastim. The patient's neutropenia resolved leading to discharge on oral antibiotics. The case reported is unique, as it links NEC to Streptococcus gallolyticus and seminoma. Streptococcus gallolyticus has not been previously associated with NEC.

Anti-N-Methyl-D-Aspartate Receptor Encephalopathy in a Young Female.

Widely distributed in the central nervous system (CNS), N-methyl-D-aspartate receptors (NMDARs) are believed to be involved in long-term potentiation, essential in regulating and forming memory. This condition primarily occurs in young females because of autoantibodies forming against the N-methyl-D-aspartate receptor-1 (NR1) or N-methyl-D-aspartate receptor-2 (NR2) subunits of NMDAR in the CNS, ultimately portraying a unique psychoneurological phenomenon. Patients with antibodies against NMDAR present with a combination of neurological and psychiatric signs and symptoms. This article presents a case of a young female with no significant past medical, psychological, or surgical history. While being previously diagnosed with acute psychosis, upon arrival at the emergency department (ED), she also displayed an acute decline in judgment, hallucinations, severe agitation, and peculiar behavior, prompting family members to seek medical attention. Consequently, she was evaluated for metabolic and infectious encephalopathy. Following a thorough examination and extensive laboratory imaging, the patient was found to have NMDAR antibody encephalopathy. After dedicated treatment, her two-month follow-up presented a complete resolution of symptoms.

Knotted Nasogastric Tube Removed With a Bronchoscope.

Nasogastric (NG) tube insertion is a routine procedure performed for a variety of indications, such as delivering enteral nutrition. NG tubes can be associated with complications, including knotting of the tube. The case of a 68-year-old who was admitted to the hospital for AIDS complicated by septic shock is presented. The patient received an NG tube to provide enteral nutrition, which was subsequently found to be clogged. An X-ray of the pharynx revealed a knot at the distal end of the NG tube. The knotted NG tube was removed with a fiberoptic bronchoscope through the nostril. The knotting of an NG tube is a rare complication. Clinicians should be aware of alternative methods of removing knotted NG tubes, including the use of a fiberoptic bronchoscope.

Eruptive Xanthomas Precipitated by Severe Hypertriglyceridemia From Diabetes and Alcohol Use.

Hypertriglyceridemia is a common abnormality found in patients in the clinical setting. Severe hypertriglyceridemia may manifest phenotypically as eruptive xanthomas, which are red or yellow papules found on the skin, most commonly on extensor surfaces and buttocks. We present a case of severe hypertriglyceridemia in a patient found in the outpatient setting, which manifested as eruptive xanthomas in his posterior upper arms, back, buttocks, axilla, and legs. Laboratory testing of his lipid profile revealed extremely high triglyceride levels, and the patient was immediately referred to the nearest hospital where he was admitted to the intensive care unit (ICU). He was promptly managed with a low-fat diet, anti-hypertriglyceridemic agents, and insulin infusion, with a dramatic reduction in triglyceride levels. He subsequently underwent a skin biopsy which confirmed the diagnosis of eruptive xanthoma. Rapid reduction in triglyceride levels is instrumental in the prevention of complications, most notably, acute pancreatitis. This article highlights the importance of a high index of suspicion for recognition of the signs and symptoms of severe hypertriglyceridemia, as well as the different management options available for the control of triglyceride levels and the prevention of complications.

Dental Infection Causing Methicillin-Resistant Staphylococcus aureus Bacteremia and Spinal Infection: A Case Report.

Poor dentition as a source of infection causing bacteremia and spinal infections (such as paraspinal abscess, and discitis) should be considered even in the absence of recent dental surgery. The case presents a patient found to have an infection in the cervical and thoracic spine, methicillin-resistant Staphylococcus aureus bacteremia, and poor dentition. Although the patient had a history of drug use, he denied a history of intravenous drug use. He had Crohn's disease that resulted in periodontal and endodontal tooth disease. The patient was found to have poor dentition with erythematous gums. He had not been to the dentist in over 24 years and had active dental caries. Since he presented with bacteremia and a spinal infection, it is likely the patient had an infection in the oral cavity that spread hematogenously to the blood, and then the spine. This report highlights the importance of considering tooth infections as the source of bacteremia and spinal infections.

Takotsubo Cardiomyopathy Induced by Stress From Amyotrophic Lateral Sclerosis and a Mechanical Fall.

Named after the Japanese octopus trap, Takotsubo cardiomyopathy is an acute myocardial condition characterized by a reversible ventricular dysfunction with ballooning of the left ventricle (LV) during systole. A catecholamine surge is likely the primary mechanism responsible for myocardial damage in this condition. The association between amyotrophic lateral sclerosis (ALS) and Takotsubo cardiomyopathy has not been well established. We present a unique case of Takotsubo cardiomyopathy diagnosed in a patient with ALS who presented after a fall with shortness of breath, generalized weakness, and hypotension. She was found to have troponinemia, elevated brain natriuretic peptide, and Osborn waves without ST-segment changes noted on electrocardiography (EKG). The diagnosis of Takotsubo cardiomyopathy was confirmed via transthoracic echocardiography (TTE), which revealed reduced left ventricular ejection fraction, apical ballooning of the LV, akinesis of the ventricular apex, and hyperkinesis of the base of the heart. Coronary angiography revealed no coronary artery disease. She was managed medically and was hemodynamically stable at the time of discharge.