Unraveling the Puzzle: The Secret Hideout of Methicillin-Resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent nosocomial pathogen known for causing severe disseminated infections. Recently, there has been an increase in community-acquired MRSA infections. We present a case of MRSA bacteremia complicated by a cervical epidural abscess. A 63-year-old female with no significant past medical history presented with altered mental status lasting two days. She had recently experienced neck stiffness after lifting a heavy object, initially diagnosed as torticollis, at an outside facility. On examination, she appeared ill and met the criteria for sepsis. Blood cultures confirmed MRSA. She developed hypotension, and an MRI of the brain and cervical spine revealed leptomeningeal enhancement and an epidural abscess. MRSA bacteremia, although common, can manifest in various forms. While it typically occurs in patients with identifiable risk factors, our patient had none. Identifying the source of bacteremia is crucial, as effective treatment requires both source control and antibiotic therapy. Given MRSA's high morbidity and mortality, a thorough and rigorous approach to assessment and management is essential.

Life-Threatening Hemoptysis From Aorto-Bronchial Fistula in a Patient With Remote History of Aortic Coarctation Repair.

"Hemoptysis" refers to the expectoration of blood from the respiratory tract. However, "life-threatening hemoptysis" includes any volume that leads to features such as airway obstruction, hypoxia, or hemodynamic instability. We present a case of life-threatening hemoptysis in a 65-year-old male with a history of benign prostatic hyperplasia and uncontrolled hypertension. Radiological investigations revealed a pseudo-aneurysm at the site of a prior thoracic aortic coarctation repair more than 50 years prior in childhood. He required vascular surgical intervention, during which there was evidence of an aorta-bronchial fistula as the likely cause of bleeding. Following the repair and optimal blood pressure control, the patient had no further episodes of hemoptysis and was discharged from the hospital. His case not only adds to the growing body of medical literature reporting hemoptysis as a complication of coarctation repair but also highlights the aorto-bronchial fistula as a possible and potentially catastrophic mechanism for bleeding in these patients.

Not All Back Pain Is Muscle Strain: A Case of Epidural Abscess.

Epidural abscesses are rare suppurative abscesses of the central nervous system that can expand and lead to severe neurologic complications and even death. Here we describe the case of a 68-year-old female who developed a spinal epidural abscess one month following cervical spinal decompression and fusion. The patient presented with decreased grip strength, flaccid paralysis of the lower extremities with hyporeflexia, urinary incontinence, and decreased sensation in the bilateral lower extremities. A cervical spine MRI revealed a large cervical spinal epidural abscess causing multilevel spinal cord compression that was treated with surgical evacuation and antibiotics. Due to the complications of epidural abscess, we as clinicians must have high clinical suspicion to initiate the correct treatment. In addition, patients without neurological symptoms or symptoms lasting less than 36 hours have the best recovery rate. Our case highlights the importance of timely diagnosis, management, and intervention, which can lead to restored functionality and the prevention of permanent neurologic sequelae.

Transient Ischemic Attack Shakes: A Case Report.

Transient ischemic attack (TIA) shakes can present as epilepsy which could lead to misdiagnosis. When a patient present with neurological findings we must ensure our differentials remain broad. As a physician, we must ensure our role in analyzing the full clinical picture of our patients. We present the case of a 75-year-old man with multiple comorbidities who presented with limb shaking and seizure-like symptoms and who was found to have bilateral carotid stenosis. After finding bilateral carotid stenosis, it ultimately led to the diagnosis of "TIA Shakes." Overall, this case re-emphasizes the importance of diagnosis and correctly managing our patients.

Large Fibroepithelial Stromal Polyp of the Breast Nipple.

Fibroepithelial stromal polyps (FEPs) are benign tumors of the integumentary system with mesodermal origin. They are commonly found over the skin. Rarely, they can be found in the nipple. We report a case in a 62-year-old female with a large FEP emerging from the left breast nipple. It started as a "mole" 10 years ago and slowly progressed in size. The patient did not complain of pain but did report occasional bloody discharge. She has no family history of breast cancer. On physical exam, a pedunculated large polyp, with rubbery consistency, emerging from the left nipple was noted. The lesion consisted of hyper-pigmentation with scattered ulcerations and cauliflower-like growth. Surgical excision was performed and histopathologic analysis showed extensive fibrovascular tissue with dense collagen fibers deposition consistent with FEP. Surgical treatment is curative with minimal skin deformity. In order to make the diagnosis and exclude malignancy, histopathology is mandatory.