Recurrent, Multisubtype Posttransplant Lymphoproliferative Disorder Masquerading as Inflammatory Bowel Disease.

Posttransplant lymphoproliferative disorder (PTLD) is a severe posttransplant complication that occurs because of immunosuppression within the first year; however, recurrent PTLD or development of multiple histologic subtypes are rare. Our case demonstrates a renal transplant recipient with rare, recurrent PTLD with multiple histologic subtypes (monomorphic and polymorphic PTLD) despite a previous response to rituximab and resolution of inflammatory changes on endoscopy. It is essential that clinicians maintain a high suspicion for PTLD when caring for patients with previous transplantation and that they have a lower threshold for biopsy with endoscopic findings of nonspecific inflammatory changes.

Diabetic Ketoacidosis and Acute Mesenteric Ischemia in Adults: An Underreported Association.

Acute mesenteric ischemia (AMI) is a rapidly fatal abdominal process that has been associated with diabetic ketoacidosis (DKA). This association has been reported among pediatric patients but has rarely been reported in adult patients. This case series presents two adult patients who presented with DKA and were subsequently found to have AMI. The first case is that of a 60-year-old male with a history of insulin-dependent type II diabetes mellitus who had a presentation and laboratory values consistent with DKA. He developed hypovolemic shock and worsening acidosis, and computed tomography angiography (CTA) revealed superior mesenteric artery occlusion. The second case is that of a 41-year-old male with a history of type I diabetes mellitus who presented with DKA and had no improvement despite aggressive resuscitation with fluids and insulin therapy. Computed tomography (CT) imaging of the abdomen revealed pneumatosis of the small bowel, indicative of ischemia. Both patients underwent bowel resection in the operating room. Given the high mortality and morbidity of AMI, it is an important diagnosis to consider in patients with DKA who have unresolving acidosis.

Euglycemic Diabetic Ketoacidosis in a Pregnant Woman With Severe COVID-19: A Case Report.

Euglycemic diabetic ketoacidosis (DKA) of pregnancy is an uncommon but serious condition that poses a substantial risk to the fetus. The physiological state of pregnancy itself predisposes women to ketosis and ketoacidosis, which can be further exacerbated by acute stressors such as infection. In this article, we describe a case of a pregnant woman with gestational diabetes and coronavirus disease 2019 (COVID-19) requiring mechanical ventilation who developed euglycemic DKA during her hospital course. Despite treating the patient with standard DKA protocol, fetal heart monitoring was non-reassuring and, hence, a cesarean section was performed. Postoperatively, her DKA resolved; however, she was maintained on supportive ventilation for continued management of her severe COVID-19 infection. In light of the ongoing pandemic, it is essential that healthcare teams closely monitor pregnant women presenting with COVID-19 infection for early signs of euglycemic DKA so that treatment may be initiated early and feto-maternal complications are avoided.

Fibrilo-Tactoid Glomerulonephritis: A Possible Novel Morphological Variant.

Fibrillary and immunotactoid glomerulonephritis are infrequent causes of primary nephrotic range proteinuria and are poorly understood. Recent significant developments include the discovery of DNA JB9 antigen in fibrillary glomerulonephritis. Here, we present a case of a middle-aged woman who presented with nephrotic range proteinuria, hematuria, and normal renal function. Renal biopsy revealed fibrils that were randomly arranged on electron microscopy. They were of small size and congo red negative similar to the ones found in fibrillary glomerulonephritis, but were also DNA JB 9 negative, and had a hollow core like in immunotactoid glomerulopathy. Though we try to classify these conditions into either immunotactoid glomerulonephropathy (ITGN) or fibrillary glomerulonephritis (FGN), there are scenarios such as this case where it does not fit into either and is probably an overlap or intermediate variant of these two conditions. Pathological features of these glomerulonephrites are discussed together with their clinical implications, treatment choices, and diagnostic importance.