Navigating Complexities: A Case of Multiple Abdominopelvic Vascular Compression Syndromes in Ehlers-Danlos Syndrome.

Abdominopelvic vascular compression syndromes (VCS) refer to conditions where blood vessels in the abdomen or pelvis are compressed by nearby structures, leading to various symptoms and complications. These conditions include superior mesenteric artery syndrome (SMAS), nutcracker syndrome (NCS), May-Thurner syndrome (MTS), and median arcuate ligament syndrome (MALS). Each syndrome is characterized by specific compressions of blood vessels, resulting in symptoms such as pain, nausea, vomiting, weight loss, leg swelling, and other related issues. Ehlers-Danlos syndrome (EDS), characterized by hyperelasticity, altered collagen, and mobility of the viscera, has been associated with VCS, although the exact prevalence is unknown. We report a case of a patient with EDS who presented with multiple VCS, including NCS, MTS, SMAS, and MALS.

Right Upper Quadrant Pain: A Rare Presentation of Diverticulitis.

Acute diverticulitis is a prevalent medical condition with increasing incidence rates. While the sigmoid colon is the most commonly affected part of the large intestine, there have been occurrences of right-sided diverticulitis although uncommon. We present a case report highlighting the atypical presentation of diverticulitis in a 27-year-old female patient. The patient experienced right upper and epigastric pain and was ultimately diagnosed with right-sided diverticulitis, supported by her CT imaging findings. This uncommon presentation underscores the importance of considering diverse clinical manifestations when diagnosing and managing diverticulitis.

Latex Fruit Syndrome as a Case of a Lower GI Bleed.

Latex-fruit syndrome is characterized by hypersensitivity reactions to certain plant-derived foods in individuals allergic to natural rubber latex (NRL), affecting approximately 30-50% of NRL-allergic patients. This condition arises due to the cross-reactivity of IgE antibodies. Over time, this syndrome has been associated with an increased number of plant sources, including avocado, banana, chestnut, kiwi, peach, tomato, potato, and bell pepper. We present a case of an art student who developed latex-fruit syndrome following prolonged exposure to NRL art supplies.

Osteomyelitis Caused by Citrobacter koseri in a Young Immunocompetent Man.

Citrobacter koseri is a non-sporulating, motile, gram-negative, facultative anaerobic bacteria found in various environmental sources, including the human intestine. It is considered an opportunistic infection as it typically causes infection in newborns, elderly, and immunocompromised patients. Common sites of infection are the urinary tract, gastrointestinal system, and respiratory tract in immunocompromised adults, as well as the bloodstream and meninges in newborns. However, osteomyelitis secondary to C. koseri is very rare. We present an unusual case of Citrobacter osteomyelitis in a healthy young man with no identifiable risk factors.

Exploring the Efficacy of Ketamine as an Anesthetic and Antidepressant in Postpartum Depression: A Case Study Analysis.

Postpartum depression is a common mental health disorder that affects women within six months after giving birth. It is characterized by sadness, anxiety, and extreme fatigue, which can significantly impact a woman's daily functioning and ability to care for her newborn. While traditional treatments for postpartum depression include therapy and medication, recent studies have shown promising results using ketamine. We present a case of a woman with a history of depression who delivered four children by cesarean section with debilitating postpartum depression in two births and no symptoms of depression in the births where she received ketamine during delivery.

Dual Dialysis for Post-bilateral Orthotopic Lung Transplantation Hyperammonemia.

Hyperammonemia is a metabolic disorder characterized by supraphysiologic ammonia (NH3) concentrations in the blood. Although usually seen in adults with liver disease, hyperammonemia is a notable complication in 4.1% of lung transplants. It is associated with cerebral edema and neurological dysfunction and carries up to 75% mortality in critically ill patients. Opportunistic infections caused by Mycoplasma and Ureaplasma species have been implicated as the cause of this metabolic disturbance. Literature in neonates has shown that renal replacement therapy (RRT) is the best choice for treating patients with neurologic manifestations of hyperammonemia, in cases of NH3 clearance than continuous renal replacement therapy (CRRT). In contrast, continuous venovenous hemodialysis (CVVHD) is usually better tolerated for patients with hemodynamic instability for NH3 clearance. NH3 is a small molecule whose clearance mirrors urea in dialysis. Even though RRT can be a treatment modality for hyperammonemia in adults and neonates, there is very little literature on adults. We present a unique case demonstrating improvement in neurologic manifestations of hyperammonemia by using both IHD and CVVHD in an adult patient.

Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure.

Keto diet is defined as a high-fat, adequate-protein, and low-carbohydrate nutrition which forces the body to burn fats and use an alternative metabolic fuel resource by stimulating endogenous ketone production. The standard range of ketones in ketosis is up to 3.00mmol/L, and anything beyond this level can result in serious medical conditions. This diet's most common and easily reversible consequences are constipation, low-grade acidosis, hypoglycemia, kidney stones, and increased lipid in the blood. We present a case of a 36-year-old female who presented with pre-renal azotemia after starting a keto diet regimen.

Orbital B-cell Lymphoma Masquerading As Dry Eye Disease.

Orbital lymphoma is a rare tumor with an incidence of 2.02 per million per year. It can occur as a part of systemic lymphoma or spontaneously arise primarily in orbit. The most commonly reported malignant lymphoma is non-Hodgkin's lymphoma. The typical clinical finding includes exophthalmos, swelling, and limited eye movement. Our patient presented with dryness and irritation of the eye without signs of proptosis until months later. The definitive diagnosis of orbital lymphoma requires a biopsy. Still, imaging studies such as MRI and CT scans play a critical role in distinguishing benign from malignant lesions and invasion of local tissues. The treatment of orbital lymphoma is multidisciplinary, involving surgical resection, radiotherapy, and chemotherapy depending on the histological type of tumor and the presence of metastasis.

Suprapubic Osteomyelitis in an Intravenous Drug User: A Case Report.

We discuss a case of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis pubis in a 45-year-old female patient with an active history of intravenous (IV) drug injection. While IV drug users are typically infected with Pseudomonas aeruginosa in cases of osteomyelitis of the pubic symphysis, our patient presented with a rare case of MRSA infection of the pubis symphysis. In this case, an investigation using magnetic resonance imaging (MRI), elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and culture was consistent with the diagnosis of osteomyelitis. Osteomyelitis pubis is an infection that causes necrosis and destruction of the pubic bone. This condition remains a rarity, as less than 1% of osteomyelitis cases are reported to involve the pubic symphysis, thus contributing to the delays observed between onset of symptoms and diagnosis. The goal of this case report is to promote awareness of this phenomenon to hasten diagnosis and early treatment. The recommended treatment is with IV antibiotics for MRSA coverage for four to six weeks' duration; however, our patient left against medical advice.

Thoracic Gut Entrapment Presenting As Intractable Hypoxia: A Case Report of Chilaiditi Syndrome.

We present a rare case of a patient who had intractable hypoxia and was found to have Chilaiditi syndrome. The hypoxia and respiratory symptoms resolved after bowel decompression and relief of the mass effect of the entrapped gut in the thorax. Chilaiditi sign is the interposition of the colon between the liver and diaphragm. Colonic interposition is a common asymptomatic radiological finding, in Chilaiditi syndrome, patients experience symptoms such as abdominal pain, constipation, respiratory distress, and chest pain.

Secondary Immune Thrombocytopenic Purpura Due to Primary Epstein- Barr Virus Infection.

A rare complication of infectious mononucleosis is immune thrombocytopenic purpura (ITP). The majority of people affected by Epstein-Barr Virus (EBV) are below the age of 30, while ITP is usually seen with peaks of incidence in the elderly and children. The unique case of an otherwise healthy 22-year-old female will be discussed, with an initial presentation of ecchymosis, rash, and epistaxis, and was subsequently found to have severe thrombocytopenia. The diagnosis of primary EBV infection due to EBV was eventually made, responsive to intravenous (IV) Methylprednisolone. It is important to consider primary EBV infection in the differential diagnosis of a patient who presents with acute thrombocytopenia.

Thyroid Eye Disease With Divergence Insufficiency Causing Recurrent Falls in an Elderly Patient.

Recurrent falls are a common cause of morbidity in the elderly population, as more than one-third of individuals aged 65 years or older experience falls each year. Falls remain a multifactorial phenomenon that can potentially result in devastating debilitation and hence require proper medical attention and management. In an elderly patient presenting with recurrent falls, the workup for differential diagnoses remains wide with various causes such as postural hypotension, syncope, seizures, arrhythmia, medication-induced, and cognitive impairment. In this report, we discuss an interesting case of recurrent falls in an elderly woman with hyperthyroidism who was repeatedly found to have unremarkable lab results and negative imaging studies. She was later diagnosed with divergence insufficiency with intermittent esotropia secondary to thyroid ophthalmopathy, which was the cause of her underlying horizontal diplopia contributing to her falls. This can cause blurry vision at further distances, which is observed especially in individuals older than 50 years. Treatment typically involves prism therapy, surgery in refractory patients, and, currently, novel therapy using teprotumumab infusion. The patient was referred to see a strabismus specialist for prism prescription and possible surgical intervention. In elderly patients with a history of recurrent falls, a comprehensive visual exam should be strongly considered, especially for individuals with repeated negative workups, to prevent further testing or procedures.

The Need to Anticoagulate Patients With Splenic Vein Thrombosis.

Splenic vein thrombosis (SVT) is a well-recognized complication of acute and chronic pancreatitis. It is associated with complications of significant gastrointestinal bleeding and high morbidity if the thrombus propagates. There is a need to consider several factors in choosing whether to anticoagulate the patient. We report a case of SVT in a patient with a previous history of pancreatitis who presented with abdominal pain, nausea, and vomiting to the hospital. At the hospital, a CT scan revealed SVT. This case highlights the importance of undergoing further studies regarding anticoagulation for treating SVT in patients at risk for gastrointestinal bleeding.

Epstein-Barr Virus-Positive Not Otherwise Specified (EBV+ NOS) Lymphoma Presentation of Primary Bone Tumor Underlying a Pathological Fracture.

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma (NHL) and accounts for approximately 25% of all NHLs in developed countries. The patients usually present with constitutional symptoms and rapidly enlarging lymphadenopathy and symptomatic mass typically located in the neck or abdomen, along with an aggressive disease course. Most of the patients present with advanced disease with 60% presenting with stage 3 or 4, and those who present with extranodal involvement are usually seen at an earlier stage. Different conditions are associated with non-Hodgkin's lymphoma ranging from hereditary immunodeficiency disorders, autoimmune disorders, infections such as HIV, Epstein-Barr virus (EBV), hepatitis C virus (HCV), Helicobacter pylori, and drugs such as immunosuppressants and chemotherapeutic agents. Epstein-Barr virus (EBV) is the main etiology of DLBCLs with an identified cause and it accounts for 10% of all DLBCLs.  We report a case of a 51-year-old woman who came with a non-traumatic left femur fracture and was subsequently found to have EBV-positive DLBCL. Lymphoma commonly presents as a lymph node swelling and it's uncommon to present as primary bone disease.

Dysphagia Lusoria Causing Aspiration Pneumonitis in a Patient With Recurrent Pancreatitis.

Dysphagia lusoria (DL) occurs due to an aberrant right subclavian artery (ARSA) compressing the esophagus resulting in dysphagia, odynophagia, and/or reflux symptoms. It is diagnosed by barium esophagram followed by a CT scan or MRI. In this case report, there is a 44-year-old male with a chronic history of reflux and a cough that presents after a meal. The case was complicated due to the history of the patient's alcoholism with recurrent pancreatitis. A CT scan was obtained during his admission, which showed pleural effusion, atelectasis, aspiration pneumonia, and an incidental aberrant RCA. Although DL is a rare pathology, 60%-80% of patients remain asymptomatic, and patients with symptoms can be managed conservatively or surgically, depending on their severity.

Nocardia in an Immunocompetent Host Masquerading As Lung Cancer: A Case Report.

Nocardiosis is generally regarded as an opportunistic infection that can present as a cutaneous, pulmonary, or disseminated disease based on host immunity status. Pulmonary nocardiosis is typically seen in immunocompromised patients; however, it can rarely be present in immunocompetent patients. We present a rare case of an immunocompetent patient who was thought to have a lung malignancy but was found to have pulmonary nocardiosis upon further investigation.

Recurrent Bacterial Infections in Cutaneous T-cell Lymphoma.

Cutaneous T-cell lymphoma (CTCL) is a dermatologically manifesting immune cell disorder. We present a case of a 76-year-old female with a past medical history of CTCL, presenting with cellulitis of the left foot. After diagnosis of CTCL, the patient was admitted multiple times for treatment of cutaneous and soft-tissue infections with methicillin-resistant Staphylococcus aureus. Her recurrent infection with S. aureus had led to treatment for sepsis and a below-knee amputation on the right during prior hospitalizations. On this admission, the patient was treated with intravenous vancomycin and cefepime as in-patient and oral linezolid as out-patient. Recent articles show that patients with CTCL have an increased tendency to harbor S. aureus, which leads to recurrent infections. Additionally, evidence suggests that S. aureus toxins aid the progression of CTCL by helping the cancer to escape immune regulation. Our patient demonstrates this unique relationship between CTCL and S. aureus, and moreover, we make a case that S. aureus infection in CTCL, as compared to that in other dermatitis, should be better managed to not exacerbate the disease.

What Works for One May Not Work for Another: A New Warning for Modafinil.

Narcolepsy is a clinical syndrome of hypothalamic disorder characterized by several sleep-wake disorders. The most common features include daytime sleepiness associated with hallucinations (hypnagogic and hypnopompic hallucinations) at the transition time of sleep-wake time, cataplexy or sudden loss of muscle tone, and sleep paralysis. We present a case of a patient affected with both narcolepsy and postural orthostatic tachycardia syndrome (POTS). POTS is a rare disorder characterized by orthostatic intolerance and abnormal autonomic response while sustaining an upright posture. In this case report, we highlight the impact of POTS on the choice of pharmacotherapy for narcolepsy.

Correction: What Works for One May Not Work for Another: A New Warning for Modafinil.

[This corrects the article DOI: 10.7759/cureus.27287.].

Exacerbation of Secondary Cold Agglutinin Syndrome in the Setting of SARS-CoV-2.

In this report, we present a case of exacerbation of cold agglutinin syndrome (CAS) potentially due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. An 83-year-old female with a history of cold agglutinin hemolytic anemia presented with shortness of breath, productive cough, worsening orthopnea, darkening fingers and urine, and jaundice. Laboratory investigations found elevated white blood cells (WBC) and total bilirubin, severely low hemoglobin, and positive direct Coombs test. Moreover, SARS-CoV-2 RNA was also found to be positive in a sample from the nasal swab by reverse transcription-polymerase chain reaction (RT-PCR), indicating exacerbation of CAS secondary to viral coronavirus 2019 (COVID-19) infection. A treatment regime for SARS-CoV-2 consisting of five days of remdesivir and seven days of dexamethasone 6 mg IV was initiated, resulting in significant improvement in the patient's condition.