Search

Sporothrix schenkii sensu latois a rare cause of arthritis. Its course is indolent with lack of constitutional symptoms resulting in delayed presentation and diagnosis. It is a dimorphic fungus found ubiquitously in sphagnum moss, decaying vegetation, soil, and hay. Inoculation of dirt into the skin and soft tissues and, in rare instances, inhalation of aerosolized conidia from soil and plants can lead to infection. Subacute and chronic involvement of skin and subcutaneous tissues is the most common manifestation of sporotrichosis in immunocompetent hosts. In patients with underlying risk factors (HIV, alcoholism, diabetes mellitus, organ transplant patients, immunosuppressive medications, steroids, and malignancies), it can often have disseminated visceral, osteoarticular, meningeal, and pulmonary involvement. Sporothrical arthritis most commonly infects knee joint followed by hand and wrist joints. A culture ofSporothrix schenkii sensu latois the gold standard for the diagnosis of sporotrichosis. Itraconazole is the drug of choice for osteoarticular sporotrichosis. We present a case of sporotrichal arthritis in a patient without skin or lymph node involvement who underwent treatment with itraconazole resulting in resolution of his symptoms.

No, it should be done only in certain situations, for example, if pneumothorax is suspected.

Intra-abdominal infections and infected fluid collections are the result of local infection typically involving the gastrointestinal or genitourinary tract. These infections are usually polymicrobial. The management of such patients should include source control and appropriate antimicrobial therapy. Source control is essential and can be achieved either surgically or by percutaneous drainage of intra-abdominal fluid collection. Interventional radiology drainage of intra-abdominal fluid collections may be especially important in patients with high surgical risk or in patients who refuse surgery. Below, we present a case of successful use of recombinant intraperitoneal tissue plasminogen activator use in a patient with a complex polymicrobial fluid collection.

She also has jaundice, hepatomegaly, and multiple abnormal laboratory results. What is the next step?

Leukostasis is a poorly understood and life-threatening complication of acute hyperleukocytic leukemia. The incidence of hyperleukocytosis and leukostasis differs among various subtypes of leukemias. While the pathophysiology of leukostasis is not fully understood, recent research has elucidated many novel pathways that may have therapeutic implications in the future. Respiratory and neurological compromise represents the classical clinical manifestations of leukostasis. If it is not diagnosed and treated rapidly, the one-week mortality rate is approximately 40%. Targeted induction chemotherapy is an important component of the successful treatment of leukostasis, although other modalities of cytoreduction are being used and investigated. Copyright © 2016 John Wiley & Sons, Ltd.

TTE is a good starting point, but TEE is indicated in patients with a high pretest probability of endocarditis.

Peripherally inserted central catheter (PICC) migration into azygos vein (AV) is a rare complication. It is recognised only when catheter malfunction occurs or when patients develop associated complications. PICC migration into AV has been reported to be associated with various complications such as catheter malfunction, perforation, haemorrhage, thrombosis, infection and stenosis of AV. Pleural effusion and trachea–azygos fistulas have also been reported. We present a patient with recurrent migration of PICC into AV after an initial corrective repositioning during the same hospital stay. In this case, PICC migration was possibly related to left-sided approach, use of smaller diameter PICC, severe congestive heart failure and her bedbound status. PICC migration should be considered when PICC found be malfunctioning, especially if associated with the above risk factors.

Hypercalcemia of malignancy is a common finding typically found in patients with advanced stage cancers. We aimed to provide an updated review on the etiology, pathogenesis, clinical presentation, and management of malignancy-related hypercalcemia. We searched PubMed/Medline, Scopus, Embase, and Web of Science for original articles, case reports, and case series articles focused on hypercalcemia of malignancy published from 1950 to December 2014. Hypercalcemia of malignancy usually presents with markedly elevated calcium levels and therefore, usually severely symptomatic. Several major mechanisms are responsible for the development of hypercalcemia of malignancy including parathyroid hormone-related peptide-mediated humoral hypercalcemia, osteolytic metastases-related hypercalcemia, 1,25 Vitamin D-mediated hypercalcemia, and parathyroid hormone-mediated hypercalcemia in patients with parathyroid carcinoma and extra parathyroid cancers. Diagnosis should include the history and physical examination as well as measurement of the above mediators of hypercalcemia. Management includes hydration, calcitonin, bisphosphonates, denosumab, and in certain patients, prednisone and cinacalcet. Patients with advanced underlying kidney disease and refractory severe hypercalcemia should be considered for hemodialysis. Hematology or oncology and palliative care specialists should be involved early to guide the options of cancer targeted therapies and help the patients and their closed ones with the discussion of comfort-oriented care.

We read the article by Monash et al. published in the March 2017 issue with great interest. This randomized study showed a discrepancy between patients' and residents' satisfaction with standardized rounds; for example, residents reported less autonomy, efficiency, teaching, and longer time of rounds.

The patient has poorly controlled HIV, seizures, and brain lesions. Is Histoplasma or Toxoplasma the cause of the lesions?

Brain imaging should precede lumbar puncture in patients with focal neurologic deficits or immunodeficiency, or with altered mental status or seizures during the previous week. However, lumbar puncture can be safely done in most patients without first obtaining brain imaging. Empiric antibiotic and

A 52-year-old male with no significant past medical history reports increasing generalized fatigue and weakness for the past 2 weeks. Physical examination reveals jaundice and pallor without organomegaly or lymphadenopathy. His hemoglobin was 5.9 g/dL with a mean corpuscular volume of 87.1 fL and elevated red blood cell distribution width of 30.7%. His liver function test was normal except for elevated total bilirubin of 3.7 mg/dL. Serum LDH was 701 IU/L, and serum haptoglobin was undetectable. Further investigation revealed serum vitamin B12 of

The drug rash with eosinophilia and systemic symptoms syndrome also known as DRESS syndrome refers to an idiosyncratic drug reaction commonly characterized by rashes, fever, lymphadenopathy, and internal organ involvement. We report a case of this syndrome in a 40-year-old man presenting with a rash, generalized pruritus, lymphadenopathy, and eosinophilia after metformin treatment. To the best of our knowledge, this is the first report linking metformin to the DRESS syndrome. The patient improved remarkably with drug withdrawal. A high index of clinical suspicion is emphasized to facilitate prompt diagnosis of medication related adverse effect and its discontinuation. In this article, we review the recent literature on DRESS syndrome.

Patient: Female, 61 Final Diagnosis: Reverse Takotsubo Symptoms: Dyspnea • chest pain Medication: Lisinopril • Metoprolol • Aspirin • Atorvastatin • Ticagrelor Clinical Procedure: Cardiac catheterization Specialty: Cardiology Objective: Rare disease Background: Reverse Takotsubo cardiomyopathy is one of the rarest types of stress-induced cardiomyopathy, which despite sharing similar pathogenic mechanisms with its more common counterpart, has different clinical manifestations, demographics, and laboratory values. Case Report: We present the case of a 61-year-old woman who came to the hospital with a chief complaint of chest pain and dyspnea. She was found to have elevated troponin and severely depressed left ventricular function. Echocardiography showed normal contracting apex, with the rest of the left ventricle being hypokinetic. Cardiac catheterization revealed mild coronary artery disease and confirmed echocardiographic findings showing hyperkinetic apex and dilated base. She was discharged home on ACE inhibitor and B-blocker. A repeat echocardiogram 2 weeks after the initial presentation showed complete resolution of cardiac dysfunction. Conclusions: Reverse Takotsubo cardiomyopathy is a rare disease mimicking acute coronary syndrome. It is essential to rule out organic coronary disease prior to attributing the presentation to Takotsubo cardiomyopathy. With supportive care, the long-term prognosis is good in the vast majority of patients.

Chronic back pain is a common presenting complaint that is frequently encountered by clinicians. The challenge for clinicians is identifying the relatively few patients with a significant probability of a more serious problem that requires further evaluation. Such individuals require further evaluation for possible occult malignancy, infection, or fracture. We present a case of a 50-year-old male with a past medical history of chronic back pain and IV drug abuse who presented with acute back pain and in whom a diagnosis of vertebral osteomyelitis was missed during multiple visits to the emergency room.

The estimated annual incidence for drug-induced thrombocytopenia is 10 per million. Although fatal consequences are uncommon, life-threatening hemorrhage can occur due to spontaneous bleeding. We report a case of 84-year-old Caucasian female who presented to the emergency department with multiple episodes of bloody bowel movements. One week prior to this admission, she was started on trimethoprim-sulfamethoxazole for the treatment of skin abscess. On admission laboratory results showed platelet count of 4 × 103/mm3and hemoglobin of 10.2 g/dL. Because of unstable vital signs, the patient was transferred to the intensive care unit where she received multiple units of platelet and blood transfusion. Drug-induced thrombocytopenia due to TMP/SMX was suspected. Intravenous methylprednisolone was started as well as immune globulin with good clinical response.

Chest pain is one of the most common reasons for emergency department visits. Emergency medicine doctors should focus their initial assessment on patients’ stability. History, physical examination, and ancillary testing should exclude serious causes such as acute coronary syndrome, acute aortic syndromes, pulmonary embolism, pneumothorax, esophageal perforation, and rupture as well as pericardial tamponade. Young age should not be used alone as a predictor of a benign condition. Below we present a case of a 24-year-old female who was found to have ascending aortic dissection and was sent for emergent surgery.

A 49-year-old woman presented with occipital headaches, dizziness, photophobia and vomiting for 2 weeks’ status post posterior scalp mole removal by a general surgeon. The physical examination revealed occipital lesions with foul smelling purulent discharge mixed with clear fluid drainage, webbed neck with decreased range of motion, facial asymmetry and a low posterior hairline. A CT of head showed occipital skull defect providing a communicating pathway for scalp infection, an atlas fusion defect and an extensive pneumoencephaly. Further imaging showed low-lying cerebellar tonsils and fusion of the body of second and third cervical vertebrae. Klippel-Feil syndrome was diagnosed and the patient was successfully managed with duraplasty of occipital dura, placement of a lumbar drain and antibiotics. In patients with findings suggestive of Klippel-Feil syndrome and lesions proximal to the CNS, appropriate neuroimaging and possible neurosurgical consult should be considered prior to any surgical intervention.

Small cell neuroendocrine carcinoma of the paranasal sinuses is an extremely rare and aggressive neoplasm. Despite aggressive management, the tumor carries a poor prognosis, with a high risk of local recurrence or distant metastases. The management strategy is based on that for pulmonary small cell cancer and includes platinum-based chemotherapy combined with radiotherapy. We are reporting a case of an 89-year-old female patient diagnosed with small cell carcinoma of right-sided ethmoid and sphenoid sinuses. The tumor was found to have invaded the right orbit and anterior cranial fossa. Metastases to cervical lymph nodes and bone were also found. Due to the extended stage and poor prognosis of the patient, the management plan is palliative chemoradiotherapy.

Hairy cell leukemia is a rare lymphoid neoplasm arising from mature B-lymphocytes. Clinically, the disease presents with splenomegaly and abdominal discomfort, frequent infections, fatigue and bleeding because of related cytopenias. Bone marrow biopsy is essential for diagnosis. Below we describe a case of a 70-year-old African-American male who presented to our hematology clinic complaining of fatigue. Clinical exam and computed tomography imaging did not reveal splenic enlargement. Blood work-up revealed pancytopenia and bone marrow was diagnostic for hairy cell leukemia.The patient was started on cladribine, with gradual improvement of his symptoms and blood count abnormalities. Therefore, it is essential to keep hairy cell leukemia in the differential of pancytopenia even in the absence of a splenomegaly.

An 81-year-old man with a medical history of hypertension, hyperlipidaemia, chronic kidney disease, coronary artery disease presented to the ear, nose and throat (ENT) physician with symptoms of hoarseness of voice which had persisted for over 6 weeks. Otolaryngoscopy was negative for obvious malignancy and he was diagnosed as having left vocal cord paralysis with a suspicion of thoracic aorta pathology. CT angiogram showed type B dissecting aortic aneurysm …

Delirium is a common pathologic event in both medical and surgical patients. It is essential to note that patients who develop delirium have worse long term outcomes. The etiology and pathogenesis of delirium are extremely complex and not entirely understood. Certain medications classes are implicated in delirium. For example, medications targeting muscarinic acetylcholine receptors are well known to be associated with delirium and altered mentation. Propofol is a medication commonly used in anesthesiology practice and sedation in intubated patients. In vitro studies provided evidence that propofol actively interacts with muscarinic acetylcholine receptors. Additionally, some, but not all clinical studies demonstrated that propofol led to delirium. Therefore, future prospective studies investigating the use of propofol and delirium occurrence are of paramount importance. These studies should adjust for such common confounders as patients’ demographics and age, comorbid conditions, use of other medications, type of surgery, baseline cognitive status, etc. Another important task would be to research the susceptibility for propofol-related delirium. By studying these critical questions, we will gain additional insights into the complex etiology and pathobiology of delirium in addition to a better understanding of the pharmacology of propofol.

The association between autoimmune rheumatic diseases and obstructive sleep apnea (OSA) is complex. Systemic inflammation secondary to OSA may underlie this association. It is possible that OSA-related inflammation may trigger the occurrence of autoimmune rheumatic disease in genetically susceptible individuals. On the other hand, autoimmune rheumatic diseases can lead to OSA or worsen preexisting OSA. Temporomandibular joint destruction, cervical spine subluxation and brainstem compression are the factors responsible for the above observation. Future studies are needed to clarify whether OSA is an independent risk factor for the development of autoimmune disease and whether OSA management will lead to a reduction in the incidence of autoimmune disease. On the other hand, it is important to treat autoimmune rheumatic disease promptly, to reduce the risk of complications, with OSA being one of these.

A 55-year-old man with a medical history of intrahepatic cholangiocarcinoma treated with gemcitabine and cisplatin with tumour chemoembolisation. However, the patient failed the initial therapy and was subsequently switched to fluorouracil and oxaliplatin with folinic acid. CT of the chest and abdomen showed new lesions consistent with metastatic disease in the liver and lungs and worsening ascites. In February 2013, the patient was admitted to the hospital because of progressive left upper extremity weakness and a mechanical fall. The …

A 29-year-old Caucasian man presented for the evaluation of a new onset of shortness of breath associated with cough and wheeze for 1 day. The history was significant for a recent travel of 20 h duration to Houston, a new onset of cigarette smoking for 2 weeks and marijuana smoking. The patient was afebrile and did not have any leg swelling; initial diagnosis of community-acquired pneumonia was made and the patient was started on antibiotics. Despite being on antibiotics, his medical condition continued to deteriorate and extensive diagnostic workup for infectious and autoimmune aetiology including bronchoalveolar lavage was completed and was inconclusive. Ultimately, the patient underwent video-assisted thoracoscopic lung biopsy which led to the diagnosis of acute eosinophilic pneumonia. Steroids were started with a good treatment response. The patient was discharged on a tapering dose of steroids; a follow-up chest x ray at 6 weeks was within normal limits.

A 69-year-old man with a medical history of HIV infection and prostate cancer presented to our practice complaining of lower abdominal pain and rectal bleeding. Prostate cancer was diagnosed in 1990, for which the patient underwent radiation therapy, bilateral orchiectomy and was managed with flutamide for several years. Twelve years after the initial diagnosis, he underwent prostate cryoablation. However, prostate-specific antigen continued to rise …

A 70-year-old woman, resident of a nursing home presented with complaints of fever for 1 day. Initial history, physical examination and laboratory tests were consistent with the diagnosis of systemic inflammatory response syndrome; blood culture from peripheral and central perm catheter were sent. Patient was started on empiric antibiotics and aggressive hydration. Blood cultures from peripheral access and central perm catheter grew Elisabethkingia meningoseptica on the second day. Patient was transferred to the intensive care unit for septic shock where patient needed vasopressors. Antibiotics were switched to intravenous trimethoprim-sulfamethoxazole, perm catheter was removed and catheter tip culture was sent. Catheter tip grew E meningoseptica (45 colony forming units). Patient showed excellent treatment response to intravenous trimethoprim-sulfamethoxazole and was weaned off pressors on day 4 with uneventful stay afterwards.

A 43-year-old gravida 2 para 2 Caucasian female with a past medical history of menorrhagia secondary to uterine fibroids and thyroid disease presented to the emergency department with complaints of bruising in her oral mucosa and vaginal bleeding. One week prior to this presentation, she was transfused with two units of packed red blood cells because of symptomatic anemia secondary to menorrhagia. Physical examination was normal, except for petechiae on the abdomen and the lower extremities as well as purpuric lesions on the buccal mucosa. Blood work revealed thrombocytopenia. Posttransfusion thrombocytopenia was suspected. The patient was transfused with washed and leukoreduced platelets and treated with steroids and intravenous immunoglobulins. Laboratory studies demonstrated that she was homozygous for the HPA-Ib/1b platelet gene and positive antibodies against class 1 HLA and platelet glycoproteins. The patient responded well to treatment, with normalization of her platelet count.

A 21-year-old woman was admitted to the hospital because of sudden onset of severe abdominal pain, nausea and vomiting. The patient also experienced decreased appetite and non-intentional weight loss of approximately 45.3 kg during the past year. Family history was positive for colon cancer in the patient's maternal grandmother (diagnosed in her 40s), and two maternal aunts diagnosed at ages 34 and 38, respectively. One of the patient's aunts tested …

Obstructive sleep apnea is common in patients with cardiovascular disease. It is well known that cardiac surgery is a risk factor for delirium. Researchers have shown that obstructive sleep apnea is an independent risk factor for the occurrence of delirium. In this manuscript we speculate on how obstructive sleep apnea may increase the risk of delirium in patients with cardiac surgery. If this is found to be confirmed, we would have another target through which we can decrease the risk of delirium in this population.

An 86-year-old Caucasian woman with a medical history of monoclonal gammopathy of undetermined significance (MGUS) was admitted to the hospital with a chief complaint of sudden onset of bluish discolouration of the fifth left hand digit. On a physical examination, cyanosis of the fifth digit of the left hand was noticed with decreased capillary fill but no ulcers. The patient had no tenderness on palpation. Pulses were palpable over the radial arteries bilaterally. Patients with MGUS may be at increased risk of thromboembolic disease. A clear explanation for this association in these patients is not currently known. This case report highlights the association between MGUS and thromboembolic events, particularly blue finger syndrome.

Multicentric reticulohistiocytosis is a rare multisystem disorder of unknown etiology that is characterized by erosive polyarthritis and papulonodular lesions on the skin, mucous membranes, and internal organs. We report the case of a 54-year-old female who was misdiagnosed as having rheumatoid arthritis and underwent numerous joint replacement surgeries for progressively destructive arthritis in her hands, shoulders, hips, and knees. The patient finally received a diagnosis of multicentric reticulohistiocytosis after histopathological examination of the patient’s left knee arthroplasty which revealed a diffuse histiocytic infiltrate, multinucleated giant cells, and finely granulated eosinophilic cytoplasm with a ground-glass appearance.

Drug-induced immune hemolytic anemia is a rare condition with an incidence of 1 per million of the population. We report the case of a 36-year-old female who presented to the emergency department complaining of shortness of breath and dark colored urine. Physical examination was significant for pale mucous membranes. The patient reported using ibuprofen for a few days prior to presentation. Complete blood count performed before starting ibuprofen revealed normal platelets and hemoglobin values. On admission, the patient had evidence of hemolytic anemia with hemoglobin of 4.9 g/dL, hematocrit of 14.2%, lactate dehydrogenase 435 IU/L, and reticulocytosis 23.2%. Further testing ruled out autoimmune disease, lymphoma, and leukemia as etiologies for the patient’s new onset hemolytic anemia. Ibuprofen was immediately stopped with a gradual hematologic recovery within 3 days.

Obstructive sleep apnea (OSA) is a common and underdiagnosed medical disorder. OSA is associated with the symptoms of excessive daytime sleepiness (EDS). These patients typically follow a sedentary lifestyle, and sedentary behavior is related to impaired fluid dynamics in the lower body, particularly the legs. In a supine position this fluid can move towards the neck, with a subsequent increase in upper airway (UA) resistance and UA collapse. Several studies have shown that rostral fluid shift worsens OSA; however, whether physical activity can influence this has not been tested. Physical activity related improvement in OSA severity cannot be fully explained by a weight loss in the performed studies, which is of particular importance. One of the potential additional pathways is via an improvement in leg fluid dynamics, with a subsequent decrease in the supine fluid shift toward the neck, since physical activity improves leg fluid dynamics. It is likely that patients with fluid overload states such as heart failure, chronic kidney disease and resistant arterial hypertension, as well as patients with EDS are likely to benefit the most from physical exercise in terms of better leg fluid clearance, and potentially in terms of OSA severity. However, none of the studies have directly assessed the potential effect of physical activity on the leg fluid volume, and more importantly on the supine fluid shift and OSA severity. These questions should be addressed in future studies of the effects of physical exercise on OSA severity.

I read the article by Chou et al with particular interest. he authors analyzed 10,185 patients (5680 with sleep apea) from the National Database to study the potential nterrelationship between obstructive sleep apnea and deep enous thrombosis. After performing regression analysis, hey found that obstructive sleep apnea increased the deep enous thrombosis risk 3.113 times (P .02). Overall, this ork provided more solid information that obstructive sleep pnea may be a novel risk factor for deep venous thrombois. However, some aspects merit further consideration. First, the authors fairly noted that they did not study the mpact of weight and smoking status (known risk factors or deep venous thrombosis) in their analysis, which may rofoundly impact the conclusions of the study. Second, they did not analyze physical activity among tudied participants, which can be different among the roups because patients with obstructive sleep apnea and aytime symptoms have a lower level of physical activity. Third, they did not specify the cancer stage and types ecause malignancies have different risk for deep venous hrombosis. Another important issue is that they did not follow-up the patients with deep venous thrombosis because some of them may be diagnosed with cancers several years later.

87 year old Caucasian female with chronic painless non-healing ulcers over malleoli was admitted to the hospital. On a physical examination, there were two bilateral and laterally located malleoli ulcers with no discharge. A thorough work up was done: lower extremities venous and arterial Doppler ultrasound did not show any evidence of venous and arterial disease respectively. Heterozygous G20210A Prothrombin gene mutation was found, and the patient was started on anticoagulation. This case reports highlights a possibility of a painless livedoid vasculopathy presentation in a patient without significant past thrombotic events. Therefore, it is important to consider livedoid vasculopathy in the differential in a patient with painless ulcerative, atrophic and/or nodular skin lesions over the shins and malleoli.

Background Leptin, an adipocytokine produced by adipose tissue, along with the traditional cardiometabolic risk factors, contributes to the development of cardiovascular complications. At the same time, ethnic features of adipocytokines have been insufficiently investigated, especially among Asians, who have an increased risk of cardiovascular complications compared with Europeans. Aim of study was to investigate the relationship between leptin levels and age, gender, anthropometric parameters, lipid parameters, arterial hypertension (AH), and obesity in the adult population of ethnic Kyrgyz people living in Central Asia. Results In total, 322 ethnic Kyrgyz (145 men, 177 women) aged ≥ 30 years were studied. Waist and hip circumference, body mass index, blood glucose, lipids, leptin, and homeostatic model assessment were measured. Patients in the upper quartile of leptin levels had high values of BMI, WC, systolic and diastolic blood pressure, glucose, and HOMA index compared with patients with lower leptin levels. The prevalence of metabolic syndrome and AH increased with higher levels of leptin. Leptin positively correlated with BMI, WC, triglycerides, and glucose concentrations in patients of both sexes. According to the multivariate logistic regression analysis, elevated leptin levels increased by 30 times the risk of obesity in men, regardless of the presence of type 2 diabetes, and 17.7 times in women. Conclusion Leptin is associated with general and abdominal obesity, dyslipidemia, and insulin resistance in Kyrgyz patients.

A 69-year-old Caucasian women presented to the clinic with haemoptysis. Review of the systems was otherwise negative. Her medical history was significant for uterine carcinosarcoma, which was diagnosed 3 years ago and treated with total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection with chemotherapy and radiation therapy. Physical examination was non-contributory. Chest X-ray (CXR) revealed right upper lobe mass-like density concerning for a malignancy (figure 1). Figure 1 Chest X-ray showing right upper lobe mass. Subsequent CT …

A 57-year-old woman was diagnosed with serous papillary ovarian adenocarcinoma, for which she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and appendectomy (omentum, appendix and other organs other than left ovary were grossly normal). CT scan of the chest was done, which showed prevascular lymph node measuring up to 4.5 cm (figure 1). The lymph node was biopsied, which stained …

A 59-year-old man with squamous cell carcinoma of the anus diagnosed and treated with wide local excision followed by chemotherapy and pelvic radiation in 2008 presented 4 years later with constipation. Colonoscopy revealed rectosigmoid stricture for which the patient underwent balloon dilation and colonic stent placement. Biopsy results were negative for tumour recurrence. After stent placement, the patient had been admitted several times with rectal pain with the most recent one being 1–2 months before. That time, colonoscopy did not show any stent malfunctioning, and biopsy was negative for malignancy and diverticulitis. This time the patient presented complaining of dysuria, frequency and fecaluria accompanied by abdominal pain for several weeks. Urine analysis showed pyuria, bacteria and positive nitrite. A …

A 74-year-old man with a medical history of hypertension, hypercholesterolaemia was diagnosed with distal oesophageal adenocarcinoma in June 2009. Prior to that the patient unintentionally lost 15 kg in 5 months and had difficulty swallowing both solids and liquids. An Oesophagectomy was performed, and he was subsequently treated with adjuvant chemotherapy including carboplatin, paclitaxel as well as radiation therapy. In May 2012, positron emission tomography was performed which showed increased uptake in the left supraclavicular node and paraoesophageal nodes (T3N1M0). Biopsy was performed, which showed tumour recurrence, which was positive for human epidermal growth factor receptor …