Sinistral Portal Hypertension Due to a Pancreatic Pseudocyst: A Rare Cause of Upper Gastrointestinal Bleeding.

Sinistral portal hypertension (SPH), also known as segmental portal hypertension, is a complication of pancreatic disorders and an extremely rare cause of upper gastrointestinal (GI) bleeding. SPH is observed in patients without cirrhosis and arises from splenic vein thrombosis. Unmitigated backflow of blood may cause gastric venous congestion and ultimately GI hemorrhage. Herein, we report a rare case of massive hematemesis due to SPH in a male patient with a history of chronic pancreatitis and pancreatic pseudocyst. Our patient was successfully treated with endoscopic necrosectomy followed by open splenectomy, distal pancreatectomy, and partial gastric resection.

A Rare Case of Immunoglobulin G4-Related Constrictive Pericarditis Diagnosed Via Multimodality Imaging.

Constrictive pericarditis (CP) presents as a pathophysiological state where the pericardium becomes inelastic due to fibrotic changes, most commonly secondary to a protracted inflammatory process. The disease is characterized by compromised diastolic cardiac function due to loss of pericardial compliance. Immunoglobulin G4 (IgG4)-related disease, an entity marked by the insidious proliferation of IgG4-positive plasma cells and subsequent fibrosis within various organs, is an infrequent but recognized cause of CP. A case of a 55-year-old male patient with clinical manifestations of dyspnea and edema in the lower extremities elucidates the diagnostic complexity inherent to CP. Echocardiography revealed a constellation of signs, including annulus reversus, septal bounce, and a congested inferior vena cava; cardiac magnetic resonance imaging (MRI) demonstrated diffuse pericardial thickening with delayed gadolinium enhancement, suggestive of a long-term inflammatory state; and right heart catheterization confirmed the hemodynamic hallmark of CP-equalization of diastolic pressures across the cardiac chambers. The serological analysis elicited elevated serum levels of IgG4 and IgE, pointing to the differential diagnosis of IgG4-related disease. Given the nonspecific clinical presentation of IgG4-related CP, a heightened index of suspicion combined with a systematic approach to imaging and serological evaluation is paramount.

The Great Imitator: A Case of Lyme Carditis Mimicking ST Elevation Myocardial Infarction.

Lyme disease, caused by Borrelia burgdorferi and transmitted via Ixodes ticks, is a common vector-borne illness in the United States, with an estimated 476,000 annual cases. While primarily known for its neurological and rheumatological manifestations, Lyme disease can also involve the cardiac system, known as Lyme carditis, which occurs in about 4% to 10% of cases. This case report details a rare instance of Lyme carditis presenting as ST-segment elevation myocardial infarction (STEMI) in a 31-year-old female with no significant medical history. The patient exhibited symptoms of chest pressure and shortness of breath, with laboratory results showing significantly elevated troponin levels and other indicative markers. Notably, cardiac catheterization revealed no coronary occlusion, suggesting an alternative diagnosis to acute coronary syndrome (ACS). Further testing confirmed Lyme carditis through positive serological tests for Lyme-specific IgM antibodies. The case underscores the importance of considering Lyme myopericarditis in differential diagnoses for STEMI in Lyme-endemic areas and in patients without typical risk factors for coronary artery disease. This report aims to increase clinical awareness of this condition, highlighting the need for thorough investigation in atypical cardiac presentations.

Acute Diarrhea Isn't Always Infectious: An Atypical Presentation of Adrenal Insufficiency.

Adrenal insufficiency can be a primary or secondary disorder occurring from a hormone deficiency or suppression of the hypothalamic-pituitary axis from various etiologies. The diagnosis can be challenging given the lack of specificity and indolence of symptoms. Diarrhea is not a typical presenting symptom of adrenal insufficiency and can be overlooked as an infectious disease during an adrenal crisis. Herein we present a patient with an undiagnosed adrenal insufficiency who presented with subacute diarrhea during an adrenal crisis after a dental procedure and esophagogastroduodenoscopy.

Intracranial Hemorrhage Secondary to Vaping: A Case Report and Literature Review.

Vaping and marijuana use are becoming more common and accessible in young adults. However, questions remain regarding their long-term health implications. Current literature does not suggest that vaping causes intracranial hemorrhages. Here, we present a case of a 32-year-old male with no medical history other than vaping and marijuana use, who was found to have an acute intraventricular hemorrhage presenting as syncope. This paper explores the relationships between vaping, marijuana use, and strokes in the general population, and further elaborates on the effects of vaping in young adults. We hope to raise awareness of the negative health implications vaping has on otherwise healthy patients and encourage clinicians to take thorough histories and identify those who vape so that comprehensive education can be provided.

A Challenging Situation: Empirical Treatment with Therapeutic Plasma Exchange in a Patient with Sickle Cell Disease.

Sickle Cell Disease (SSD) can present with acute painful crises, most commonly manifesting as diffuse bony pain; however, rare presentations of acute coronary syndrome, acute papillary necrosis, or multi-organ failure may also present in these patients. TTP has been rarely described in conjunction with sickle cell pain crisis (SS crisis). In both TTP and sickle cell crises, widespread platelet activation is present with thrombocytopenia as a result. Thrombocytopenia can be utilized as a poor prognostic indicator in patients with SS crisis. Multi-organ failure may appear similar to TTP and patients may benefit from similar therapy. Here, we present a 27-year-old female with a history of SSD who presented with a painful crisis who was found to have worsening renal failure and thrombocytopenia and was treated empirically with therapeutic plasma exchange (TPE), later discovered to have SS crisis with multi-organ failure with unremarkable ADAMSTS13 values. Given the high fatality risk of TTP, the benefits outweighed the risks for empiric TPE therapy, and our patient benefited from the treatment, as patients with both TTP and/or SS crisis multi-organ failure have demonstrated improvement following this treatment. Given the severity of multi-organ failure in SSD patients, additional research is warranted for improvement in the diagnosis and management of these patients.