Gastric Sarcoidosis: A Difficult to Diagnose Rare Disease

Abstract Gastrointestinal sarcoidosis is a rare clinical entity. Diagnosis of isolated gastric sarcoidosis is difficult as it is usually asymptomatic; when symptomatic it presents with non-specific symptoms such as abdominal pain, nausea and vomiting. We here present a case of a 32-year-old black lady who presented with non-specific abdominal complaints; a diagnosis gastric sarcoidosis was established following endoscopic biopsy. Here symptoms resolved promptly with steroidal therapy as with most cases. Gastric sarcoidosis should be suspected in sarcoid patients who present with nonspecific abdominal complaints. This case serves as an important clinical reminder of the atypical manifestations of sarcoidosis

Pickering Syndrome precipitated by Angiotensin Converting Enzyme Inhibitor

Abstract Pickering syndrome is an under recognised cardio-renal syndrome where life threatening flash pulmonary edema develops in the setting of diastolic dysfunction of the heart. Renal artery stenosis induced activation of sympathetic nervous system and renin-angiotensin-aldosterone system result in fluid retention; such fluid retention in the setting of diastolic dysfunction results in flash pulmonary edema. Most patients who present with pickering syndrome have normal coronary circulation and left ventricular systolic function. We here present a case of pickering syndrome that was precipitated by initiation of angiotensin converting enzyme inhibitor therapy in a patient with undiagnosed unilateral renal artery stenosis. The incidence of flash pulmonary edema decreases on revascularization of renal artery stenosis. Underlying renal artery stenosis should be suspected in a patient with recurrent flash pulmonary edema as such patients merit from revascularization of renal artery stenosis. To the best of our knowledge we are the first to report angiotensin converting enzyme inhibitors as a precipitator of pickering syndrome

Inhaled nitrous oxide 'whip-its!' causing subacute combined degeneration of spinal cord.

The opioid prescription drug epidemic is not the only challenging drug abuse that the United States is facing. Over the past decade, the prevalence of another substance of abuse has dramatically; increased that is nitrous oxide, also known as 'Whip-its'. As per the Substance Abuse and Mental Health Administration, there were twelve million users reported in 2012. Whip-its has become a popular trend among teenagers and young adults, as it is easily accessible. 'Whip-Its!' canisters containing nitrous oxide are available for purchase at grocery stores, on the internet, and various retailers without any age limit, warning or regulations. Reported cases of 'Whip-its' use have been linked to loss of consciousness, anoxic brain injury, cardiac arrest, and death. Yet, another result of chronic nitrous oxide abuse is that of spinal cord myelopathy due to vitamin B 12 deficiency. In this report we present a case of a 22-year-old male with daily abuse of inhaled nitrous oxide in the form of 'Whip-its', who presented with initial symptoms of presumed drug induced psychosis and gradually developed neurological focal deficits, and findings of sensorimotor peripheral neuropathy with myelopathy of the cervical spine and vitamin B12 deficiency