Hemophagocytic lymphohistiocytosis presenting as acute coronary syndrome

Acquired Hemophagocytic Lymphohistiocytosis is a rare and deadly syndrome resulting from an overactive immune system, with uncontrolled activation of macrophages and lymphocytes, hypercytokinemia, and systemic inflammatory response. A 75-year-old male presented with typical anginal pain and was diagnosed with the acute coronary syndrome, which required a percutaneous transluminal coronary angioplasty. Instead of resolving the symptoms, the patient began to exhibit pyrexia and worsening altered sensorium with progressing renal failure, anemia, thrombocytopenia and respiratory failure. This constellation of symptoms caused the patient to require mechanical ventilation and hemodialysis. Upon laboratory analysis, hyperferritinemia provided an indication to the diagnosis of acquired hemophagocytic lymphohistiocytosis. After the initiation of dexamethasone, the patient made a significant recovery and was discharged from the hospital

Encapsulating peritoneal sclerosis in liver transplant

Encapsulating peritoneal sclerosis occurs due to chronic irritation of the peritoneal surface resulting in inflammation and fibrosis. Encapsulating peritoneal sclerosis usually occurs in patients requiring peritoneal dialysis (PD); however, it may also occur in liver transplant patients. The fibrosis in encapsulating peritoneal sclerosis could be severe enough to cause small bowel obstruction (SBO). Herein, we report a case of encapsulating peritoneal sclerosis secondary to liver transplantation that presented with SBO. The patient was started on Tamoxifen for encapsulating peritoneal sclerosis and evaluated at follow-up without any other intestinal obstruction episodes. This case demonstrates that encapsulating peritoneal sclerosis can occur as a liver transplant complication and present with small bowel obstruction

Erdheim-Chester disease presenting at the central nervous system

Erdheim-Chester disease is a rare non-Langerhans cell histiocytosis (LCH) that affects different body systems. It was recently recognized as a neoplastic disorder after identifying an activating mutation of the MAPK pathway. Neurological presentations of ECD are rare. We present a case of a 35-year-old male who presented to the emergency department with neck pain, headache and vomiting for 2 months; MRI showed multiple heterogeneous intracranial masses. Neurosurgery performed a suboccipital craniotomy, partially resected the cerebellar mass, and placed a parietal to frontal shunt catheter. Biopsy results from the cerebellar mass demonstrated cerebellar tissue involved by a diffuse proliferation of foamy histiocytes and spindle cells admixed with prominent lymphoplasmacytic infiltrate and positive for CD68, CD163, Factor XIIIa and Fascin. PET scan showed hypermetabolic uptake within the medullary portions of the diffuse abnormal lesions of the distal femurs, tibias, and fibulas, and cardiac MRI was nonsignificant. The patient was started on vemurafenib and continued to show improvement in a 3-month outpatient follow-up

Patients’ reasons for missing scheduled clinic appointments and their solutions at a major urban-based academic medical center

Objective Patients that do not show up for scheduled clinic appointments affect the quality of healthcare provided. This study aimed to recognize the reasons behind missing scheduled appointments and understand possible solutions from the patient’s perspective. Method We included 100 patients that attended the outpatient Medicine clinic in January 2020. Selection criteria were based on missing one or more of the scheduled clinic appointments in the last year. The participants answered a questionnaire to clarify the reasons for missing a scheduled clinic appointment and offer suggestions for a solution. The recruiter, in turn, answered several demographical questions Results The study showed a statistically significant difference between the no-show rate in females at 60% compared to males at 40% (P = 0.0023). The no show rate was not significantly affected by the day of the week, time of appointment, or the weather. Forgetting about the appointment was the most common cause (36 subjects). Work-related issues were reported in 17 participants, making it the 2nd most common cause. Not notified about the appointment, Lack of transportation, childcare-related issues, along with other reasons, were less likely reported (Table 2). 11 out of 36 (30%) subjects suggested a reminder text message in their preferred language; meanwhile, 4 others suggested a weekend clinic. Conclusion The patients should be aware of different appointment reminders options and have the freedom to choose a suitable reminder. Patients should be educated about the importance of calling to cancel the appointment since some of the reasons for no show are unpreventable

Salmonella aortitis successfully treated with antibiotics without surgery

Aortitis is an inflammation of the aorta that is linked to large vessel vasculitis and other rheumatologic cases. Less often, an infectious etiology of aortitis is diagnosed. Aortitis is associated with high mortality and morbidity and requires a high index of suspicion. Here we present a rare case of aortitis secondary to Salmonella Septicemia treated with six weeks of antibiotics in the hospital without and remained asymptomatic and inflammatory markers normalized at 2 weeks follow up (ESR, CRP, and WBCs)