Case Reports

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A Case of 3D Printing Shaping the Future of Percutaneous Cardiac Procedures

Georgi Fram, Dee Dee Wang, and Hussayn Alrayes

Introduction: Paravalvular leaks are a highly morbid complication of surgically replaced prosthetic valves of the heart. They often present with symptoms of decompensated heart failure, and patients can become dyspneic even at rest in severe cases. Oftentimes to repair the valve, patients are not surgical candidates due to their high risk of adverse events with re-sternotomy. Percutaneous repair of these valves has emerged as an effective and safe alternative... Read More
Pyeloduodenal Fistula: A Rare Complication

Nitesh Gandhi and Jasmine-Yasmine Omar

Objectives: Diagnose pyeloduodenal fistulaManage pyeloduodenal fistulaCase: 85-year-old male with a history of bladder cancer status post tumor resection and left ureteral stent placement presented with right flank pain, hematuria, and CVA tenderness on physical exam. UA was consistent with urinary tract infection, CT abdomen pelvis showed gas and fluid in the dilated right renal pelvis and collecting system. Cystoscopy with bilateral retrograde pyelogram was performed, but urologists were unable... Read More
Malaria in Macomb, Michigan

Justin Gardner and Keith Cronovich

Evaluation of a patient in whom you suspect a tropical disease requires a thorough history. You must determine the timeline of travel as well the time course of symptom onset and progression. Determine geographic region of travel, mode of transport, sick contacts, animal exposure, insect bites, water sources, sexual contact, vaccine history, and prophylactic medications. What follows is a case of a patient who recently returned from a trip... Read More
Factitious disorder: a case report with clinical guidance for management

Mohan Gautam, Raef Fadel, Rachel Thiem, Joshua Collins, and Esther Akinyemi

Although the hospitalization of a patient with factitious disorder (FD) can incur healthcare costs that exceed $200,000, it also incurs a tremendous psychological impact on healthcare staff. We present the case of Ms. L, a 38 year old Caucasian female with severe FD. We examine psychosocial factors associated with FD and offer strategies for inpatient physicians to collaboratively manage this condition. Ms. L presented to the ED after ingesting... Read More
Air in Parameniscal Cyst: Alarming Appearance of a Benign Condition

Madison Grasty, Nicholas Laucis, and Manmeet Dhillon

Background: Parameniscal cysts are an uncommon finding in radiology and often are associated with meniscal tears. While they do not always present with symptomology, if they do they may manifest with knee pain and require radiologic studies. We present an unusual case of a parameniscal cyst which appeared remarkably similar to necrotizing fasciitis. Case Report: A 60 year old male patient with a history of gout and previous gout... Read More
Expect the Unexpected! A Rare Case of Nocardia Bacteremia

Smitha Gudipati, Kamil Khorfan, John E. McKinnon, and Erica S. Herc

Background: Nocardia species are partially acid fast, aerobic, gram-positive, branching filamentous bacteria that are found ubiquitously in the soil, decaying vegetable matter and aquatic environments. The Nocardia species most commonly associated with infections in humans are caused by asteroides (80-90%) followed by brasiliensis, farcinica and nova1. Nocardia spp. can cause serious pulmonary infections which are associated with frequent metastatic brain abscesses. Nocardia bacteremia is rarely reported and usually only... Read More
HSV Acute Retinal Necrosis – A Painful Threat to Vision

Hind Hadid, Yusuf Alalwan, Firas Askar, Kevin Leikert, Alexander Kuley, and Indira Brar

Ocular Herpes Simplex (HSV) is a serious infection with variable clinical manifestations ranging from isolated blepharitis and keratitis to vision-threatening uveitis and acute retinal necrosis (ARN). Previously described risk factors include preceding neurosurgery, older age and high-dose corticosteroids. The presence of keratitis is a valuable diagnostic sign, however, when absent, the differential is wide, encompassing autoimmune and idiopathic etiologies. We report the cases of two patients who presented with... Read More
Secondary Hyperparathyroidism Mimicking Osteomyelitis

Mohamad Hadied, Tammy Hsia, and Anne Chen

Introduction: With the advent of dialysis technology, patients with end stage renal disease have improved mortality; however, renal replacement is not without its own burdens, including endocrine disturbances such as secondary hyperparathyroidism. Though patient survival from end stage renal disease has improved in recent years, there is little published information regarding the exact incidence and burden of secondary hyperparathyroidism among renal replacement populations.This case reports examines a patient with... Read More
Malignant Transformation of a Filum Terminale Dermoid Tumor into Adenocarcinoma

Miles Hudson, Karam Asmaro, Mohamed Abouelleil, Sameah Haider, Hesham Zakaria, Ciprian Gradinaru, Abir Mukherjee, and Ian Lee

Background: Intraspinal dermoid tumors are usually rare benign growths that occur as a result of defects during neural tube formation. They make up less than 1% of tumors in the spine and are associated with spinal dysraphisms or sinus tracts. Although rare, malignant transformation into squamous cell carcinoma has been previously reported. Malignant transformation into adenocarcinoma, however, represents a novel phenotypic differentiation pattern that is hitherto undescribed.Case description: A... Read More
Falsely Elevated Testosterone Levels: Role of LC-MS/MS

Sabrina Huq and Shiri Levy

Introduction: Immunoassays, specifically chemiluminescent assays are commonly used in clinical laboratories for analyzing protein antigens and steroid hormones such as testosterone due to their availability as commercial kits, low cost and simplicity. We present a case of falsely elevated serum testosterone. Clinical Case: A 17-year-old female with facial acne was referred to us for elevated testosterone levels. She was of Greek descent and reported having had coarse dark hair... Read More
Combination immune checkpoint inhibitor-induced hypophysitis: A case report

Nathan Hyson, Allen Wrubel, Suresh C. Patel, Ishani Dalal, John Corrigan, Horia Marin, and Brent Griffith

Background: Immune checkpoint inhibitors have emerged as a promising new class of anti-cancer drugs. Unfortunately, while potentiating the immune system’s response to cancer cells, these drugs also place the patient at risk for the development of immune-related adverse events. Although most commonly involving the gastrointestinal tract and skin, involvement of the endocrine system also occurs, with hypophysitis one of the most frequent complications. This case report describes a case... Read More
Hydroxychloroquine Cardiac Toxicity in a Systemic Lupus Erythematosus Patient

Iyad Isseh, Michael Hudson, and Shalini Modi

Learning objectives: Diagnosing and identifying patients at risk of developing Hydroxychloroquine cardiac toxicity. Introduction: Hydroxychloroquine (HCQ) and Chloroquine (CQ) were initially intended to be used as antimalarial drugs and are still prescribed for prophylaxis and treatment of malaria. Their effectiveness in rheumatoid arthritis and systemic lupus erythematosus (SLE) was found serendipitously and they have now become mainstays in the treatment of many connective tissue diseases. Prior literature details HCQ... Read More
Chronic Peri-Oral Dermatitis as the First Manifestations of Crohn's Disease

Mahmoud Isseh, Mouhanna Abu Ghanimeh, Sandra Naffouj, Nicholas Horton, and Nirmal Kaur

Introduction: Oral manifestations have been reported in crohn’s disease (CD). The reported prevalence of these manifestations varies widely between studies, and range between 0.5%-50% in adults and 10%-80% in pediatrics. Oral manifestations of CD may coincide with the intestinal manifestations, or less commonly precede them. Aphthous ulcers, angular cheilitis, swelling of the lips and gingiva, cobblestoning of the mucosa, deep linear ulcers and periodontal disease have been reported in... Read More
Yellow Nail Syndrome

Angela J. Jiang, Jesse Veenstra, and Alison Boucher

HISTORY: A 62-year-old Caucasian female presented for finger and toenail yellowing with associated poor nail growth and intermittent nail shedding over the past 10 years. She also has a history of recurrent pulmonary effusions and lower extremity lymphedema that was diagnosed at approximately the same time.

EXAMINATION: There was yellow discoloration of all fingernails and toenails with prominent distal onycholysis without subungual debris. Lunula and cuticles were absent. Fingernails... Read More
Alveolar Rhabdomyosarcoma

Zachary Jump, Jonathan Zygowiec, Kelly Correa, and Marc Engelbrecht

Our case presents a rare diagnosis that will most likely never be encountered by the community emergency medicine physician. It demonstrates how a thorough physical exam and appropriate imaging can differentiate benign vs. serious processes in a common complaint, and lead to further work up and diagnosis of a serious life-threatening etiology. Alveolar Rhabdomyosarcoma is a rare soft tissue tumor seen in children and adolescents. In this case report,... Read More
Orbital Larva Masquerading as Preseptal Cellulitis

Daniel Kaitis, Shravani Mikkilineni, Daniel A. Brill, Taylor S. Fields, and Paul Baciu

Live flies in the skin around the orbit is a rare finding. We hereby report a case of ocular calliphoid fly larvae in a 69-year-old female presented with the complaints of a bump in her left upper eyelid for 2 weeks. On examination, a scolex medial to left upper eyelid that undulated and partially emerged from skin was identified. A video accompanies this case report. The patient underwent surgical... Read More
Stimulant medication cessation in the setting of non-compaction cardiomyopathy

Adan Khan and Lisa MacLean

Non-compaction cardiomyopathy (NCM) is largely a genetic condition due to failure of left ventricular compaction during embryogenesis. This results in extensions of bundles of muscle (known as trabeculations) into the chamber impairing the ability of cardiac muscle to contract or relax adequately. Individuals may be diagnosed at any age and present with shortness of breath, poor growth, dizziness, lightheadedness, syncope palpitations, swelling or unexpected weight gain. Though individuals may... Read More
Diagnosing and Managing PCP, TB and PE in an HIV Infected Patient

Omar Khan and Anne Chen

Introduction: Pulmonary manifestations in the Human immunodeficiency virus (HIV) infected patient can lead to a broad differential diagnosis. Co-infection with Pneumocystis jiroveci pneumonia (PCP) and pulmonary tuberculosis (TB) in the HIV infected patient has been described before. Additionally, HIV can lead to a hypercoagulable state placing patients at risk for VTE. This case report examines a patient with HIV presenting with PCP pneumonia, active pulmonary TB, and bilateral pulmonary... Read More