Masooma Niazi

Spectrum of ischemic colitis in cocaine users.

Ischemic enterocolitis is a well-recognizedentity occurring in cocaine users. Diagnosis is based onthe presence of rectal bleeding, abdominal pain, ahistory of cocaine use, supportive endoscopic and histopathologic findings, and the absence ofother etiologic mechanisms of ischemic colitis. In thisstudy, we evaluated endoscopic and histopathologicfindings in seven patients with cocaine colitis. Lesions seen by endoscopy, which were restricted to theleft colon, included hemorrhagic edematous mucosa,pseudopolyps, and ulcerations. Rectal involvement, nota common feature of ischemic colitis, was seen in five patients. In two patients histologiclesions were classified acute/subacute, and in threepatients as subacute/chronic. In the remaining twopatients lesions were combined acute/subacute andchronic. The presence of subacute/chronic lesionssuggested recurrent ischemic episodes and could reflectrepeated use of cocaine. Future studies will be neededto define the long-term clinical and histopathologic significance of these subacute/chroniclesions.

A Fatal Case of Multidrug Resistant Acinetobacter Necrotizing Fasciitis: The Changing Scary Face of Nosocomial Infection

Necrotizing fasciitis is an uncommon soft-tissue infection, associated with high morbidity and mortality. Early recognition and treatment are crucial for survival. Acinetobacter baumannii is rarely associated with necrotizing fasciitis. Wound infections due to A. baumannii have been described in association with severe trauma in soldiers. There are only sporadic reports of monomicrobial A. baumannii necrotizing fasciitis. We report a unique case of monomicrobial necrotizing fasciitis caused by multidrug resistant (MDR) A. baumannii, in absence of any preceding trauma, surgery, or any obvious breech in the continuity of skin or mucosa. A 48-year-old woman with history of HIV, asthma, hypertension, and tobacco and excocaine use presented with acute respiratory failure requiring mechanical ventilation. She was treated for pneumonia for 7 days and was successfully extubated. All septic work-up was negative. Two days later, she developed rapidly spreading nonblanching edema with bleb formation at the lateral aspect of right thigh. Emergent extensive debridement and fasciotomy were performed. Operative findings and histopathology were consistent with necrotizing fasciitis. Despite extensive debridement, she succumbed to septic shock in the next few hours. Blood, wound, and tissue cultures grew A. baumannii, sensitive only to amikacin and polymyxin. Histopathology was consistent with necrotizing fasciitis.

Case Report: Paraganglioma of the Pancreas

Extraadrenal paragangliomas are very rare tumors arising from cells derived from the neural crest. These tumors are encountered only as case reports, and as a result, little is known of their natural history. We present a case of pancreatic paraganglioma and review all previously reported cases.Paraganglioma, or extraadrenal pheochromocytomas, arise from paraganglia and are histologically akin to chemodectomas. They are rare, affecting about one in 2,000,000 people (1). Paragangliomas are essentially neural cells that have separated from developing autonomic ganglia. Hence, like autonomic ganglia, paraganglia are also found within organs (2). A paraganglioma arising from a visceral organ is exceedingly rare.

A 24-Year-Old Pregnant Patient With Diffuse Alveolar Hemorrhage

A 24-year-old pregnant woman was admitted to the hospital at 33 weeks’ gestation for dyspnea of 2-week duration. She had a mild dry cough and denied having chest pain, fever, hemoptysis, or night sweats. She had no arthralgias, rash, anorexia, abdominal pain, nausea, or vomiting. The patient was adherent to regular antenatal care and had been treated for a Staphylococcus aureus urinary tract infection 2 weeks prior to admission. Her gestational history included multiple spontaneous abortions due to cervical incompetence, for which she had prophylactic cerclage during this pregnancy. She denied toxic habits or travel history; her tuberculin test had been negative 6 months earlier.

Duodenal atresia associated with proximal jejunal perforations: a case report and review of the literature

Duodenal atresia is associated with Downs syndrome, malrotation, and congenital cardiac defects. Idiopathic intestinal perforations in a newborn, which are not associated with necrotizing enterocolitis (NEC), have been described. The authors report on a full-term neonate who had multiple perforations of the proximal jejunum distal to duodenal atresia. To the best of the authors knowledge, the combination of idiopathic intestinal perforation and duodenal atresia has not been reported previously.

Cholestatic Hepatitis with Small Duct Injury Associated with Celecoxib

Drug-induced liver injury (DILI) is a common clinical entity but is underreported due to various reasons. Cyclooxygenase-2 inhibitors like Celecoxib have been proven to be associated with lesser incidence of adverse drug reactions compared to other nonsteroidal anti-inflammatory drugs (NSAID). However, Celecoxib has been rarely reported to be associated with cholestasis and hepatitis. We present a young Hispanic female presented with cholestatic liver chemistries who has been taking Celecoxib for 3 weeks. Extensive workup did not support diagnosis of viral, autoimmune, or metabolic liver diseases. Liver biopsy revealed findings suggestive of secondary sclerosing cholangitis. Imaging studies were negative for large duct involvement, and endoscopy ruled out inflammatory bowel disease. Liver chemistries normalized after cessation of medication. We recommend that physician should be aware of this rare complication when prescribing Celecoxib.

Diffuse alveolar hemorrhage and acute respiratory distress syndrome during treatment of rheumatoid arthritis with etanercept.

Etanercept (Enbrel) is a drug targeted against tumor necrosis factor-&agr;, which is increasingly being used in treatment of a variety of autoimmune disorders. It has been reported to have a relatively safe profile; reported reactions have been of minor to moderate severity and range from hypersensitivity reactions, serious infections, fulminant pneumonias, and lung nodules. We report a case of diffuse alveolar hemorrhage and acute lung injury probably related to its use in a patient with rheumatoid arthritis. A high index of suspicion for noninfectious pulmonary diseases should also be considered when a patient with autoimmune disease treated with etanercept presents with pulmonary infiltrates and hypoxia refractory to antibiotics. Flexible bronchoscopy with sequential lavage should be attempted to detect and confirm the diagnosis of diffuse alveolar hemorrhage even if the patient does not have hemoptysis.

Unsuspected pulmonary alveolar proteinosis in a patient with acquired immunodeficiency syndrome: a case report

IntroductionDiffuse lung infiltrates are a common finding in patients with acquired immunodeficiency syndrome and causes range from infectious processes to malignancies or interstitial lung diseases. Pulmonary alveolar proteinosis is a rare pulmonary disorder rarely reported in patients infected with human immunodeficiency virus. Secondary pulmonary alveolar proteinosis is associated with conditions involving functional impairment or reduced numbers of alveolar macrophages. It can be caused by hematologic malignancies, inhalation of toxic dust, fumes or gases, infectious or pharmacologic immunosuppression, or lysinuric protein intolerance.Case presentationA 42-year-old African American man infected with human immunodeficiency virus was admitted with chronic respiratory symptoms and diffuse pulmonary infiltrates. Chest computed tomography revealed bilateral spontaneous pneumothoraces, for which he required bilateral chest tubes. Initial laboratory investigations did not reveal any contributory conditions. Histological examination of a lung biopsy taken during video-assisted thoracoscopy showed pulmonary alveolar proteinosis concurrent with cytomegalovirus pneumonitis. After ganciclovir treatment, our patient showed radiologic and clinical improvement.ConclusionThe differential diagnosis for patients with immunosuppression and lung infiltrates requires extensive investigations. As pulmonary alveolar proteinosis is rare, the diagnosis can be easily missed. Our case highlights the importance of invasive investigations and histology in the management of patients infected with human immunodeficiency virus and pulmonary disease who do not respond to empiric therapy.

A Rare Occurrence of Primary Hepatic Leiomyosarcoma Associated with Epstein Barr Virus Infection in an AIDs Patient

Primary hepatic leiomyosarcoma is exceedingly rare accounting for less than 1% of the hepatic tumors. Close to 45 cases have been reported in the English literature. Presentation is usually nonspecific and diagnosis is often delayed until tumors reach a large size. This leads to a dismal prognosis. The tumors are not yet fully understood, hence the standard of care is not well defined. Curative resection remains the mainstay of management. Close association of Epstein Barr virus (EBV) induced soft tissue sarcomas is proven, especially in the presence of immunosuppression encountered in HIV/AIDS patients and in posttransplant patients. We herein present a case report of a 54-year-old man diagnosed to have HIV/AIDS and EBV infection admitted to our hospital with complaints of intractable hiccups for more than a week. Extensive workup revealed primary leiomyosarcoma of the liver.

A Rare Complication of Hyperplastic Gastric Polyp

Hyperplastic gastric polyps are incidentally diagnosed during upper gastrointestinal endoscopy. They are known to cause gastric outlet obstruction and chronic blood loss leading to iron deficiency anemia. However, hyperplastic gastric polyp presenting as acute severe upper gastrointestinal bleeding is very rare. To the best of our knowledge, there have been two cases of hyperplastic gastric polyps presenting as acute gastrointestinal bleeding in the medical literature. We present a case of a 56-year-old African American woman who was admitted to our hospital with symptomatic anemia and sepsis. The patient developed acute upper gastrointestinal bleeding during her hospital stay. She underwent emergent endoscopy, but bleeding could not be controlled. She underwent emergent laparotomy and wedge resection to control the bleeding. Biopsy of surgical specimen was reported as hyperplastic gastric polyp. We recommend that physicians should be aware of this rare serious complication of hyperplastic gastric polyps as endoscopic polypectomy has diagnostic and therapeutic benefits in preventing future complications including bleeding.