Case Reports

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Malignant Cartilage Lesions of the Hand: When Enchondromas Go Bad

Elizabeth Klag, Matthew Easton, Nicole Mott, Patrick Buckley, Timothy Evans, and Michael Mott

Purpose: Primary bone malignancies of the hand are rare as most cartilage lesions are small/ benign and can be managed with local curettage and grafting. Presented here is a small case series of malignant cartilage tumors of the hand. Because histologically their pathology overlaps and mimics their benign counterparts (enchondromas), it is of upmost importance to note the clinical presentation of potential malignant transformation. Case Series: Case 1: A... Read More
Postpartum Hemorrhage Leading to Renal Infarction

Monica Kole and Madhurima Keerthy

A 19-year-old G1P0 with insignificant past medical history was admitted at 39w1d gestation for induction of labor after having category 2 fetal heart tones. Her induction was unremarkable aside from bradycardia in the second stage of labor requiring a vacuum-assisted delivery and episiotomy. Immediate postpartum course was complicated by a hemorrhage with a total estimated blood loss of 1450 cc. A CT scan was obtained to rule out retroperitoneal... Read More
Increased Collagen VII Expression with Fractional Ablative Laser Therapy in RDEB

Sasank Konda, Samantha Schneider, Marla Jahnke, Kristin Leiferman, Marsha Chaffins, Andrew Krakowski, and David Ozog

Background: Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic skin disorder resulting in severe skin fragility, frequent blisters, scarring, increased risk of squamous cell carcinomas and decreased life expectancy. RDEB results from autosomal recessive mutations in type VII collagen, which is a critical component of the basement membrane. Skin fragility can predispose patients to great morbidity and effective methods to prevent and treat these lesions are limited.Study Design/ Materials... Read More
Rapidly progressive scoliosis in a patient with Marshall-Smith Syndrome

Michael Korn, Mohsin Fidai, Kyle Morgenstern, and Joseph Perra

Case: Marshall-Smith syndrome is a rare genetic condition due to mutations in the NFIX gene resulting in a multitude of congenital abnormalities, including atlantoaxial instability and ligamentous laxity. This case report describes a patient with Marshall-Smith syndrome who developed atlantoaxial rotatory subluxation and subsequent rapidly progressive scoliosis after occiput-C2 fusion. She was treated with 4 weeks of halo traction, followed by an occiput to T3 posterior spinal fusion, segmental... Read More
Not Your Ordinary Clavicle Pain

Andrew Krause and Christopher Guyer

A 20-year-old male with no significant past medical history presents to the emergency department with pain over his right clavicle with activity. He was wrestling with friends four months ago when he was thrown down landing directly on his right shoulder. He notices pain, especially when he does push-ups, lifts his arm over his head, and while lying on his right side. He has no pain at rest. He... Read More
Pneumocystis Carinii Pneumonia: A Rare Cause of Granulomatous Hypercalcemia

Swati Kumar, Mahalakshmi Honasoge, Arti Bhan, Anita Patel, and Adarsh Babu

Pneumocystis Carinii pneumonia (PCP) is a well-known complication of immunosuppression. Scattered case reports have linked PCP and its ability to induce a granulomatous response to hypercalcemia. PCP related hypercalcemia appears to be resistant to standard therapy. We report a case of hypercalcemia that preceded PCP and continued to worsen during the course of infection. A 63y man with renal transplant for polycystic kidney disease one year prior, presented with... Read More
Radiation Induced Optic Neuritis: A Role for Steroids?

Kevin Leikert, Daniel Brill, and Poonam Bansal

Radiation induced optic neuropathy is a devastating complication of radiotherapy to the anterior visual pathway, resulting in significant, permanent vision loss. Systemic steroids have not demonstrated a proven benefit in stabilizing or reversing vision loss. We report a case of radiation induced optic neuropathy with visual acuity improvement after initiation of high dose steroids.A 55-year-old male presented with 5 days of decreased vision in the right eye. Two years... Read More
Metastatic Endometrial Serous Carcinoma to the Breast

David S. Lin, Tayson Lin, Ziying Zhang, and Biren Shah

Case Summary: This is a case of a 74-year-old post-menopausal female who presents for vaginal bleeding for several months. Endometrial curettage and subsequent histopathology arrived at the diagnosis of endometrial serous carcinoma. Subsequently, the patient developed a lump in her right breast. Mammogram of the palpable abnormality revealed a suspicious mass that was biopsied and revealed metastatic endometrial carcinoma.ImagingImaging will be reviewed including CT of the abdomen and pelvis... Read More
Acute Liver Injury Induced by Red Yeast Rice Supplement

Lize Loubser, Kristin Weider, and Sean Drake

A 64-year-old female previously taking no medications presented with acute hepatitis 6 weeks after starting a red yeast rice daily supplement to decrease her cholesterol. Red yeast rice is commonly used for hyperlipidemia as an alternative to statins as it contains monacolin K, the same active chemical in lovastatin. Infectious, toxic, and autoimmune causes for injury were ruled out, and liver biopsy was consistent with drug-induced liver injury. Red... Read More
Voriconazole Induced Bullous Phototoxicity

Chelsea Luther, Christina Artz, and Ellen N. Pritchett

Introduction: Voriconazole, commonly used for invasive aspergillosis treatment, can cause cutaneous adverse effects including photosensitivity. We outline a case of bullous phototoxicity secondary to voriconazole, a condition seldom reported.

Case Report: A 67-year-old white male was admitted for painful blisters on left foot. Three months prior, he underwent single lung transplant, which was complicated by pulmonary aspergillosis. Two months after voriconazole initiation, and during July, he developed painful tense... Read More
An Atypical Case of Atypical Teratoid Rhabdoid Tumor (ATRT)

Sharmeen Mahmood and Hadi Mohammed

Introduction: Atypical Teratoid Rhabdoid tumors are rare pediatric tumors that usually occur at age <3 years. These tumors are scarcely seen in>adults, with the first adult case appearing in 1992. Since then, about 64 cases have been reported in the literature. As such, much what has been learned about adultATRT cases has come from case reports and extrapolation frompediatric cases. The loss of INI1 (SMARCB1) or BRG1 (SMARCA4) genes... Read More
Brachial Artery Pseudoaneurysm Secondary to a Sessile Osteochondroma in an Avid Teenage Basketball Player

Lindsay Maier, Patrick Buckley, Matthew Easton, Nicole Mott, Timothy Evans, and Michael Mott

PURPOSE: Osteochondromas (OCE) are typically characterized as benign cartilaginous neoplasms occurring as either solitary lesions or as part of multiple hereditary exostosis (MHE). In some instances, they may cause pain due to irritation of nearby musculoskeletal structures such as ligaments, tendons, nerves and vessels. Growth of these lesions is often slow and mimics skeletal growth. Rapid change in the size of an OCE warrants investigation due to concern for... Read More
Warfarin for Headaches?!

Mandeep Malik and Housam Sarakbi

Background: Headaches have been extensively reported in Antiphospholipid syndrome (APS)/Antiphospholipid antibodies (aPL)-positive patients. Headaches associated with APS is often untreatable, poorly responding to analgesics or narcotics and occurs for years before the diagnosis of APS. Conventional imaging studies are usually negative. Many therapeutic agents/strategies such as hydroxychloroquine, B cell inhibition, complement inhibition, statins, and peptide therapy have been proposed to manage thrombotic APS. Nonetheless, Heparin followed by Long-term anticoagulation... Read More
Ultrasonographic and Radiographic Findings of Polyethylene Component Displacement with Severe Metallosis and Metal-Induced Synovitis Following Total Knee Arthroplasty

Shane Mallon, Kyle Bussis, Zachary Beswick, Trevor North, and Steven Soliman

Aseptic loosening and wear of arthroplasty is second to only infection as the most common complication of arthroplasty failure. Degeneration of the polyethylene and metal arthroplasty components can lead to metallosis, which can cause a combination of direct cytotoxic effects and an inflammatory response within the synovial and periarticular tissues. This can result in bone resorption and secondary arthroplasty component loosening as well as a metal containing joint effusion... Read More
Actinomyces Israelii – A Rare Cause of Bacterial Peritonitis

Georgiana Marusca, Hind Hadid, and Marcus Zervos

Background: Actinomyces, a filamentous, gram-positive, facultative anaerobic bacterium, is part of the commensal flora of the oral cavity, gastrointestinal tract and the female genital tract. Actinomyces have low virulence potential and cause opportunistic infection associated with injury to the mucosal barrier, such as that occurring from surgery, trauma, peritoneal dialysis catheter, viscus perforation or intrauterine devices. Infections associated with actinomyces are often reported by imaging studies as masses, pseudotumors... Read More
Mechanical Mitral Valve Re-Thrombosis - Surgery, Lysis or Just Good Ol' Heparin?

Sagger Mawri, Ferras Debbagh, Nancy Ly, Sachin Parikh, Marvin H. Eng, and William O'Neill

Background: Early recognition of obstructive thrombosed prosthetic heart valves (OTPHV) is crucial to prevent delays in treatment and avoid significant morbidity and mortality. Choice between surgery, thrombolysis and escalation of anticoagulation can be a challenge.

Case Presentation: A 69 year-old man with history of liver transplant, subdural hematoma (1 year ago), and St. Jude bileaflet mechanical mitral and aortic valve replacements (9 years ago) for severe MR and AR... Read More
A Novel Way to Fenestrate a Type B Dissection Flap Using Electrocautery

Dylan McLaughlin, Scott Bendix, Judith Lin, and Loay S. Kabbani

Thoracic endovascular repair (TEVAR) is the current therapy of choice for treating type B aortic dissections. This is accomplished by covering the entry tear that is distal to the left subclavian artery. When the dissection flap extends into the visceral vessels it is common to have a type 1b endoleak into the false lumen from the visceral aortic tears. When the supra-celiac aorta is of normal caliber, then fenestration... Read More
Sarcoidosis and Acute Cholecystitis

Miles Medina and Heather Cronovich

Chest Pain Cholecystitis. 50 year old male presented to the emergency department with a chief complaint of pleuritic chest pain that has been present for 10 hours, sharp in nature, and worsened with inspiration. Patient’s medical history was remarkable for sarcoidosis, hiatal hernia, GERD, and spondylosis. Of note, patient had 3 catherizations over the last three years with no evidence of coronary artery disease. Patient did not smoke nor... Read More