A Rare Cause of Lymphadenopathy in a Young Hispanic Female: Unmasking Recurrent Nodal Rosai-Dorfman Disease

Rosai-Dorfman disease (RDD) is a rare histiocytic disorder that can present with painless bilateral symmetrical cervical lymphadenopathy, mimicking lymphomas. RDD is characterized by excessive tissue infiltration by dendritic cells, macrophages, or monocyte-derived cells, with a histopathologic diagnosis based on the presence of CD68+, CD163+, and S100+ histiocytes, which differentiate it from other histiocytic neoplasms. In this case report, we present a young Hispanic female with recurrent subcutaneous growths and lymphadenopathy, initially thought to be lymphoma, who was diagnosed with RDD after a significant diagnostic workup. Treatment initially consisted of surgical excision; however, due to recurrence, the patient was successfully treated with corticosteroids and a steroid-sparing agent, 6-mercaptopurine, with significant improvement in symptoms. RDD should be considered a differential diagnosis for patients with cervical lymphadenopathy, and an interdisciplinary approach is essential to managing this rare disorder effectively. The report highlights the need for an interdisciplinary approach to managing this rare disorder effectively and underscores the importance of multimodal treatment in disease suppression. As a rare disease with slow advancement of defined guidelines for diagnostic and treatment strategies, this case report adds to the existing literature on RDD

A Challenging Case of Refractory Biliary Leak in a Patient With Hydatid Liver Disease

Hydatid liver disease (HLD) is the most common form of hydatid disease, and it is caused by a zoonotic infection with a tape worm. It is endemic mostly in sheep-farming countries and rare in the United States. Liver involvement is usually asymptomatic, but symptoms develop upon growth of the cyst leading to many complications, most common of which is intra-biliary rupture, and less likely biliary obstruction. Diagnosis is clinical, serologic and radiologic. Therapeutic approaches to HLD include surgery, anthelminthic medications and medico-surgical procedures. Here we present a case of HLD that presented in advanced stage leading to grave consequences, complicated course and difficult therapeutic options. Given the rarity of hydatid disease in Northern America, physicians have to keep high index of suspicion especially in a patient with history of travel to endemic areas, as early diagnosis and treatment is important to avoid high morbidity and mortality

Euglycemic Diabetic Ketoacidosis with a decompensated Hypothyroidism in the setting of a recent Cerebrovascular accident: A case report

Euglycemic diabetic ketoacidosis (EDKA) is an underdiagnosed endocrine emergency. It consists of an increased anion gap metabolic acidosis (pH \u3c 7.3 or serum bicarbonate \u3c 18 mmol/L), moderate ketonuria with a blood glucose levels The Patient is a 73-year-old female with a past medical history of Diabetes Mellitus, Hypertension, Hyperlipidemia, Hypothyroidism and deafness and muteness since birth. Patient had a recent ischemic stroke 5 days prior to the admission and was admitted at a different hospital for management of her stroke. Patient left against medical advice and presented to our ED later that day complaining of rectal prolapse. Of note, the patient is non-compliant with her medications. Upon admission, she is alert, oriented, and in acute distress. On her physical exam, her vital signs were within normal limits. Patient had a significant rectal prolapse with no other abnormalities seen on the exam. Lab values include glucose level of 170, Sodium of 135, HCO3 of 15, Chloride of 103, albumin level of 2.9, Anion Gap of 18, Corrected-albumin anion gap of 20.8. Her lactate level was 0.81. We obtained serum Ketones that resulted in a moderate elevation and her urinalysis showed Ketone +2. She presented no osmolar gap with a serum osmolality of 295. Her Hba1c was 12.9 and her Thyroid studies showed TSH level 32, T3 Uptake of 53.3, Total T4: 4.6 and a Free T4 0.56. Other causes of a high anion gap metabolic acidosis were ruled out and the patient was diagnosed with an EDKA. EDKA is a diagnostic challenge as normal glucose level masks the underlying ketoacidosis. Therefore, a high index of suspicion is warranted. Altogether, our patient carries multiple risk factors for EDKA including poor oral intake, a recent stroke event and poorly controlled Diabetes Mellitus. Patient was hospitalized right before her admission and suspected to have received a long-acting insulin during her stay causing her to be euglycemic. Our patient was also admitted with severe hypothyroidism, it’s effect on development of EDKA is not well studied and suspected to also play a role in this patient’s presentation [2,3]

Improving colon cancer screening/referrals based on current guidelines in an underserved area outpatient clinic.

Background: In 2021 in the US there was an estimated 1.8 million new cases of cancer and 600,000 cancer death, that means 5200 new cases per day and 1670 deaths. CRC is the 4th most common cancer diagnosed among adults and the 2ndleading cause of death from cancer. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool- based test or a structural (visual) examination, depending on patient preference and test availability. Screening with any one of multiple options is associated with a significant reduction in CRC. Objectives: The primary objective was to show that the intervention of choice leads to an improvement of percentage of the appropriate colorectal screening significantly. We also, wanted to educate residents and improve awareness of current guidelines for CRC screening. Methods: We designed a prospective, interventional study and compared the percentage of patients screened or referred for screening older than 45 years old, before and after the intervention over a six-month period. Inclusion criteria were all Hispanic and non-Hispanic, at the age of 45 to 75 seeing in the clinic from January 1st, 2021, to July 1st, 2021.The initial and primary intervention was as ground round about Colorectal cancer screening on 08/25/21. The secondary intervention were informative flyers at the dictation and conference room at the clinic about FOBTx3, FIT and Colonoscopy options for screening. The expected duration of project was a year. Results: Pre intervention, the percentage of patients screened were about 50.09%, after our intervention the percentage increased to 60.49% with a p value of 0.0006

Arterial Dissection in Antiphospholipid Syndrome Patients: Two Case Reports and a Literature Review

Antiphospholipid syndrome (APS) is a multisystemic autoimmune disease which presents with thromboembolic disease, pregnancy complications and the presence of antiphospholipid antibodies. There are some reports of arterial dissections in different sites of the body associated with APS. We describe two patients with APS who developed ischaemic stroke as a result of vertebral artery dissection in the absence of acquired and genetic risk factors for arterial dissection. We also conducted a systematic review of the literature for cases of arterial dissection associated with APS. We suspect that APS may be a potential cause of vasculopathy and arterial dissection. Further research is needed to explore this possible association

Liver Cystic Disease

Hepatic cysts (HCs) have been a common reason for consultation by gastroenterologists and hepatologists. HCs are defined as small abnormal fluid-filled lesions that develop within the liver tissue and usually arise from within hepatocytes, biliary cell epithelium, mesenchymal tissue, or metastases from extrahepatic organs. Hepatic cysts can be from an infectious or non-infectious source. They are common and usually asymptomatic. This activity reviews the evaluation and treatment of liver cystic lesions and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Describe the etiology of different hepatic cyst lesions. Identify the most common complications associated with liver cysts. Outline the typical imaging findings associated with hepatic cysts. Review some interprofessional team strategies that can result in better care coordination for patients presenting with hepatic cystic disease. Access free multiple choice questions on this topic

Arterial Dissection in Antiphospholipid Syndrome Patients: Two Case Reports and a Literature Review

Antiphospholipid syndrome (APS) is a multisystemic autoimmune disease which presents with thromboembolic disease, pregnancy complications and the presence of antiphospholipid antibodies. There are some reports of arterial dissections in different sites of the body associated with APS. We describe two patients with APS who developed ischaemic stroke as a result of vertebral artery dissection in the absence of acquired and genetic risk factors for arterial dissection. We also conducted a systematic review of the literature for cases of arterial dissection associated with APS. We suspect that APS may be a potential cause of vasculopathy and arterial dissection. Further research is needed to explore this possible association