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Eosinophilic duodenitis is an inflammation of the duodenum, characterized by an abundance of eosinophils, typically triggered by hypersensitivity reactions. Typically, recurrent abdominal pain with eosinophilic duodenitis is rare in individuals without a history of atopic conditions like asthma. Here, we present the case of a 62-year-old man who experienced recurrent upper abdominal pain for 12 months and unintended weight loss for the past six months. The patient reported no allergies to food, drugs, or the environment, and has no history of other atopic conditions. Esophagogastroduodenoscopy (EGD) with biopsy of the duodenum and stomach revealed 32 eosinophils per high-power field (HPF), which is mild. Skin prick testing yielded negative results. Following initial treatment with H2 inhibitors, proton pump inhibitors, and budesonide for a total of 12 weeks, the patient reported an improvement in symptoms and subsequent weight gain. This report emphasizes a rare case of eosinophilic duodenitis in a nonatopic individual with a successful treatment regimen. His quality of life improved with weight gain, resolved abdominal pain, and improved appetite. Although the patient's condition lasted about 12 months, our report showcased the importance of timely clinical diagnosis and appropriate combination therapy to alleviate progressive pain associated with eosinophilic duodenitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Phrathep et al.)

A 61-year-old postmenopausal female with a past medical history of type 2 diabetes, nephrolithiasis, and recurrent urinary tract infections presented to an outpatient urology clinic with a chief complaint of urinary frequency, urgency, and burning after micturition. Associated symptoms included nausea, a low-grade fever with chills, and right flank pain. After treatment with antibiotics did not relieve all of her symptoms, imaging was obtained, showing a cystic mass with calcifications in the right kidney. Following laparoscopic partial right nephrectomy and total hysterectomy with bilateral salpingo-oophorectomy, pathological examination of the right kidney mass highlighted endometrial stromal cells consistent with endometriosis of the right kidney. The left ovary also contained endometrial stromal cells, confirming another diagnosis of endometriosis of the left ovary. This case highlights the importance of considering renal endometriosis in the differential diagnosis of renal masses in women, even if they are postmenopausal., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Healey et al.)

Ureteral injury is a rare occurrence in medical practice. Most cases encountered stem from blunt trauma or are iatrogenic, occurring during open abdominal or pelvic surgery and laparoscopic procedures. Prompt diagnosis of ureteral injury allows clinicians to avoid complications including ureteral strictures, abscess, renal failure, sepsis, and loss of the ipsilateral kidney. Treatment depends on whether the ureteral injury was discovered intraoperatively or if it was a delayed diagnosis. Several procedures can be used, including ureteroureterostomy, ureteroileal interposition, and nephrectomy. Stenting can also be a viable option as it can reestablish urinary drainage. Herein, we present the case of a 43-year-old male who presented with complaints of progressive abdominal pain that was subsequently diagnosed as a left ureteral injury and how the use of a ureteral stent allowed him to have a full recovery with optimized normal ureteral function., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Herson et al.)

Urethral prolapse is a rare and benign condition where the inner urethral lining protrudes through the external urethral opening. This condition is mostly seen in prepubertal and postmenopausal women. Risk factors include obesity, multiparity, and the onset of menopause. It has a low occurrence, resulting in frequent underdiagnosis. This is compounded by its typical delayed diagnosis. We present a case of a 71-year-old postmenopausal woman who presented with persistent urinary symptoms. After multiple failed conservative treatments, she underwent a successful urethral prolapse excision. Our case highlights the importance of considering urethral prolapse as a differential diagnosis in a postmenopausal woman with continual urinary symptoms., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Healey et al.)

This case report discusses a 77-year-old female patient who presented to an outpatient clinic with urinary symptoms and recurrent UTIs. Imaging revealed a foreign body, which was later confirmed as a retained intrauterine device (IUD) that had caused a vesicouterine fistula (VUF). The patient had a medical history of cervical cancer treated with radiation therapy, during which her IUD's string could not be located, leading to the decision to proceed with radiation therapy without removing the IUD. The patient opted to manage her condition medically rather than undergo surgical removal due to concerns about worsening the vesicouterine fistula. This case highlights the potential risks and complications of retained IUDs, and the importance of careful consideration and communication among clinical teams and patients when managing these situations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Briceno et al.)

Follicular dendritic cells help advance B-Cells in becoming memory B-Cells or antibody-producing plasma cells in the light zone, or undergo additional affinity maturation in the dark zone. Follicular dendritic cell sarcoma (FDCS) is an extremely rare soft tissue malignancy derived from follicular dendritic cells. Autoimmune disease increases the risks for the development of hematological malignancies. To the best of our knowledge, there are few cases of FDCS development in the setting of underlying Sjogren's syndrome (SS). Therefore, in this report, we present a novel case of FDCS associated with new-onset SS. In SS, the follicular dendritic cells are organized within germinal centers within the glands it infiltrates and is involved in B-Cell development. Because FDCS is derived from follicular dendritic cells, our report postulates that the unregulated follicular dendritic cell proliferation that may occur in SS could increase the risk for FDCS. Due to this possible connection observed in our patient, we highlight FDCS as a differential diagnosis when considering soft tissue cancers. We urge additional research to outline and explore the possible pathologic link between SS and FDCS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Phrathep et al.)

Noncirrhotic portal hypertension (NCPH) has recently been found in human immunodeficiency virus (HIV)-infected patients taking didanosine. Here, we describe an HIV-infected patient with portal hypertension due to hepatoportal sclerosis who presented with hematemesis at the emergency department (ED). CT angiography of the abdomen and pelvis with and without contrast revealed a diminutive portal vein with corresponding massive lower esophageal varices and superior mesenteric vein to the right gonadal vein varices. Esophagogastroduodenoscopy (EGD) revealed grade II varices were found in the lower third of the esophagus, for which the patient's symptoms improved with emergency endoscopic band ligation, octreotide and didanosine discontinuation. Our case demonstrates a rare complication that can occur with continued didanosine use in an HIV-positive patient. We highlight the need for a standard diagnostic upper gastrointestinal endoscopy to screen for portal hypertension and high-risk esophageal varices in patients with long-term didanosine use as seen in our patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Phrathep et al.)

Breakthrough hemolysis (BTH) is the return of hemolytic disease resulting in an overall increase in complement activation in a patient being treated for paroxysmal nocturnal hemoglobinuria (PNH) with complement inhibitors (CI). BTH after COVID-19 vaccination has only been reported in PNH patients treated with the traditional C5 CI eculizumab and ravulizumab. We report on a new association of BTH in a newly COVID-19 vaccinated, previously stable PNH patient treated with pegcetacoplan, a C3 CI. The patient is a 29-year-old female diagnosed with PNH in 2017 and was started on eculizumab but was switched to pegcetacoplan in 2021 after continuing to exhibit symptomatic hemolysis. Subsequently, the patient returned to PNH remission serologically and symptomatically until her first COVID-19 vaccination. Since then, her lactate dehydrogenase (LDH) and hemoglobin counts have not fully returned to previous baseline levels, with significant exacerbations after her second COVID-19 vaccine and de novo COVID-19 infection. As of May 2022, the patient requires packed red blood cell transfusions every two to three months and has undergone a bone marrow transplant evaluation. This case study suggests that the administration of the upstream C3 CI, pegcetacoplan, is associated with active extravascular hemolysis in the setting of COVID-19 vaccinations and active COVID-19 infection. The pathophysiology of this hemolysis is unclear as hemolysis could be related to the underlying complement factor deficiency or amplification of complement factors causing extravascular hemolysis. There are conflicting reports in the literature regarding the mechanism by which COVID-19 vaccination and infection cause BTH in PNH patients, regardless of the choice of CI treatment. Bringing awareness to this case of BTH secondary to COVID-19 in a PNH patient treated with pegcetacoplan can further warrant the investigation of the role of COVID-19 in complement disruption and its role in BTH., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Boshkos et al.)

Herpes simplex encephalitis is a rare disease presentation that is usually characterized by its temporal involvement and positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for the herpes simplex virus (HSV). HSV PCR has a sensitivity of 96% and specificity of 99%. Even when the test is negative, if clinical suspicion is high, acyclovir therapy should be continued with a repeated PCR within a week. In this case, we report a 75-year-old female patient who presented with signs of hypertensive emergency with rapid deterioration to seizure-like activity on electroencephalogram (EEG) and signs of temporal encephalitis on magnetic resonance imaging (MRI). The patient did not respond to the initial regimen of antibiotics but did show significant clinical response to acyclovir though she had a negative CSF PCR for HSV ten days after the start of her neurological symptoms. In this case, we argue that alternative methods of diagnosis should be considered in cases of acute encephalitis. Our patient had negative PCR but her computerized tomography (CT), EEG, and MRI results pointed to temporal encephalitis caused by HSV., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Phrathep et al.)

Our report highlights the diagnosis of cecal endometriosis as a unique cause of hematochezia in a postmenopausal female. Cecal endometriosis manifesting as intermittent hematochezia and abdominal pain is uncommon but requires prompt clinical diagnosis and management. We report a case of cecal endometriosis causing hematochezia and subsequent syncope, which prompted the patient's admission to the emergency department. In our patient, a diagnosis of cecal endometriosis was made after a colonoscopy, with multiple biopsies confirming the presence of endometrial tissue embedded in the cecum. We aim to bring awareness of cecal endometriosis presenting as hematochezia in a postmenopausal woman with a history of abdominal pain. This case highlights intestinal endometriosis as a differential diagnosis to be considered in women, regardless of age, with intermittent hematochezia and abdominal pain., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Quintana-Rapatalo et al.)

Ectopic gastric mucosa can be present throughout the gastrointestinal tract; however, when located within the upper esophagus, it is termed an esophageal inlet patch. To the best of our knowledge, most esophageal inlet patches occur as a single area of gastric mucosa. Here, we present a 44-year-old female who suffered from symptoms of chronic dysphagia and globus sensation for two years due to multiple inlet patches located in the cervical area of the upper esophagus with an associated cervical esophageal stricture. The patient underwent esophageal dilation and proton pump inhibitor therapy, resulting in a resolution of her symptoms. Our case demonstrates the appropriate clinical management of patients suffering from symptoms of chronic dysphagia due to multiple esophageal inlet patches. We recommend routine examination of the cervical esophagus in developing a differential diagnosis of inlet patch, especially in patients with chronic upper dysphagia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Phrathep et al.)

Eosinophilic esophagitis (EoE) is an inflammatory condition limited to the esophagus, predominantly consisting of eosinophils, and triggered by hypersensitivity reactions. Recurrent dysphagia secondary to EoE is uncommon in patients with no history of asthma and/or atopic conditions. We are presenting a case of a 48-year-old male suffering from dysphagia for 10 years that worsened over a six-month period. The patient reported no known food and drug allergies, asthma, and other atopic conditions. On esophagogastroduodenoscopy (EGD), the patient fulfilled all five endoscopic reference score (EREFS) criteria, granting a final diagnosis of eosinophilic esophagitis with a score of 6. Biopsy confirmed eosinophilic esophagitis, revealing 20 eosinophils/high-power fields. Skin prick testing was negative. His symptoms had improved at the office follow-up after three weeks after esophageal dilation and proton pump inhibitor (PPI) but did not completely resolve. The patient was then started on fluticasone 440 mcg two times a day. After eight weeks, the patient was symptom-free by taking dual therapy of PPI and fluticasone. The patient was advised to continue taking the daily PPI and then a six-week course of fluticasone if he experienced an exacerbation in his symptoms. In this report, symptom improvement with esophageal dilation, PPI, and fluticasone suggested a successful treatment regimen for EoE in the setting of no known atopy in our patient. Our case highlights EoE in an adult with no known asthma and allergies. The report identifies the importance of a prompt clinical diagnosis and appropriate combination treatment due to the progressive pain and its worsening associated with eosinophilic esophagitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ward et al.)

Post-Coronavirus disease 2019 (COVID-19) development of polymyositis is rare, with very few cases documented in the literature. In patients developing vague symptoms after recovery from COVID-19, it is important to investigate all avenues, including the possibility of polymyositis. Polymyositis is typically characterized as symmetrical muscle weakness and histological, electrical, and chemical evidence of muscle injury. Patients identified can be treated with immunosuppressants to return some quality of life and prevent disease progression. In this report, we describe a 58-year-old Caucasian male who presented with symptoms of weakness, myalgias, and arthralgias, six months after recovering from flu-like symptoms of COVID-19. The patient was tested for other autoimmune etiologies and myopathies without positive results. He was treated with prednisone and reported moderate improvement in symptoms. Unfortunately, the patient declined a muscle biopsy or electromyographic testing. According to the criteria for polymyositis set by the Myositis Association and the response to therapy, the patient's symptoms pointed to a likely diagnosis of post-COVID-19 polymyositis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Anthony et al.)

Mucormycosis (MM) is an angio-invasive fungal infection that often presents in immunocompromised patients. Isolated renal MM is an uncommon presentation that has been documented as a life-threatening condition in immunocompetent patients due to its poor prognosis. Here, we present a rare case of isolated renal MM in a 27-year-old male who presented with left flank pain, nausea, and vomiting. Upon further investigation, a renal infarct was discovered, and he underwent a subsequent nephrectomy. A renal biopsy revealed MM. The patient's infection spread, and he ultimately succumbed to his illness. Isolated renal involvement of this pathogen is extremely rare in healthy individuals and has poor outcomes. The ubiquitous nature of MM increases the risk of exposure to humans. Comorbidities such as coronavirus disease 2019 and immunosuppressive states are risk factors for the deleterious outcomes of MM. It is unusual for an immunocompetent patient with no underlying conditions to die despite early diagnosis and prompt treatment. This example calls attention to the unpredictable clinical presentation of isolated renal MM. Our case highlights MM as a differential diagnosis in patients with unilateral flank pain and identifies the importance of a prompt clinical diagnosis and treatment due to the rapid progression and poor health outcomes associated with MM infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Healey et al.)

Inguinal hernias are common anatomic defects, especially among men. Complications of inguinal hernias include incarceration, but incarcerated hernias rarely cause other disturbances. An 86-year-old man with a history of chronic kidney disease (stage IIIb) presented with recurrent urinary tract infections and acute kidney injury with sepsis. Physical examination revealed a right inguinal hernia, and non-contrast abdominal computed tomography revealed right ureteral obstruction and distal entrapment by the inguinal hernia, with hydronephrosis. The patient underwent right retrograde pyelography and ureteral stent placement, followed by laparoscopic inguinal herniorrhaphy with mesh, which restored renal function. Our case is unique among obstructive uropathies due to inguinal hernias because the distal ureter was entrapped within the bowel mesentery communicating between the peritoneal cavity and retroperitoneum. Both inguinal hernias and obstructive uropathy are common among elderly men. While the latter is often secondary to prostate malfunction, other causes of obstructive uropathy or hydronephrosis should be considered, especially if unilateral., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Healey et al.)