{"title":"Successful Endoscopic Management of Oxyntic Gland Adenoma: A Case Report.","authors":"Rajarajeshwari Ramachandran, Tyler Grantham, Jeffrey Loeffler, Madhavi Reddy, Vinaya Gaduputi","doi":"10.1177/23247096251313729","DOIUrl":"10.1177/23247096251313729","url":null,"abstract":"<p><p>Oxyntic gland adenomas (OGAs) are benign gastric neoplasms composed of gland-forming epithelial cells with predominantly chief cell differentiation resembling oxyntic glands confined to the mucosa. If the tumor has submucosal invasion, it should be classified as gastric adenocarcinoma of fundic gland type. The OGAs can pose a diagnostic challenge, as they can resemble aggressive gastric neoplasms. There are no current guidelines on the management of OGA. Due to the relatively small size and low malignant potential, these lesions are typically managed endoscopically. In this case, we are reporting a 22-year-old woman who was diagnosed with OGA during evaluation of iron deficiency anemia and underwent successful endoscopic resection.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251313729"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmad Jradi, Kaline Maya Khoury, Karam Karam, Dr Ihab I El Hajj, Elias Fiani
{"title":"Lymphocytic Esophagitis: Navigating an Uncharted Territory.","authors":"Ahmad Jradi, Kaline Maya Khoury, Karam Karam, Dr Ihab I El Hajj, Elias Fiani","doi":"10.1177/23247096251313734","DOIUrl":"10.1177/23247096251313734","url":null,"abstract":"<p><p>Lymphocytic esophagitis (LE) is an uncommon subtype of esophagitis defined by persistent esophageal inflammation characterized by a high count of intraepithelial lymphocytes with scarce granulocytes. Although LE can present with atypical features such as chest pain, its clinical presentation can mimic that of gastroesophageal reflux disease or eosinophilic esophagitis, highlighting the importance of biopsy in diagnosing LE. Studies are still limited in understanding the pathophysiology behind this disease warranting further research. A 47-year-old female patient sought medical care with a chief complaint of recurrent substernal chest pain for the past year. An esophagogastroduodenoscopy was performed and showed patchy linear esophageal erosions and mucosal edema in the middle third of the esophagus with mild erythema. Biopsies revealed intraepithelial lymphocytosis with more than 40 lymphocytes per high-power field, corroborating a diagnosis of LE. Patient reported improvement after receiving high dose of proton pump inhibitor (PPI) on her first follow-up, advised to follow a low-acid diet and an annual endoscopy to monitor her response to treatment. Lymphocytic esophagitis often presents with symptoms that overlap with other esophageal diseases explaining the possible errors in underdiagnosing it as reason behind non-cardiac chest pain. This case plays an instrumental role in changing the way physicians translate unexplained chest pain, adding LE to their list of differential diagnosis as prompt detection slows us to start management with PPIs quicker and lessen the burden of symptoms on the patient. Standardized treatment approaches and further studies are required to clarify the connection between LE and non-cardiac chest discomfort.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251313734"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jowan Al-Nusair, Olivia Lim, Leena Alhusari, Abdelwahap Elghezewi, Mahmoud Abdallah, Mohamed Alshal, Toni Pacioles
{"title":"The Challenging and Unique Diagnosis of VEXAS Syndrome: A Case Report.","authors":"Jowan Al-Nusair, Olivia Lim, Leena Alhusari, Abdelwahap Elghezewi, Mahmoud Abdallah, Mohamed Alshal, Toni Pacioles","doi":"10.1177/23247096251325416","DOIUrl":"10.1177/23247096251325416","url":null,"abstract":"<p><p>VEXAS syndrome, a myeloid-driven autoinflammatory disorder associated with somatic mutations in the UBA1 gene, was first described in 2020 and presents significant diagnostic challenges due to its complex clinical features, including hematological abnormalities and autoimmune manifestations. We describe a case involving a 64-year-old male presenting with persistent anemia, weight loss, fatigue, fever, and recurrent inflammatory symptoms. Diagnostic workup, including imaging, serology, and bone marrow biopsy, revealed characteristic findings, including myeloid hyperplasia, and vacuolization in precursor cells. Genetic testing identified a UBA1 gene mutation, solidifying the diagnosis of VEXAS syndrome. The patient responded to immunosuppressive treatment with prednisone and ruxolitinib, with significant improvement in symptoms. This case tells us the importance of considering VEXAS syndrome in patients with refractory systemic inflammation and hematological abnormalities, particularly in older males. Early recognition and genetic testing are crucial for guiding treatment decisions, as the condition is progressive, often relapsing, and requires multidisciplinary management.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251325416"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehrbod Vakhshoori, Paul E Hanna, Zainab Obaidi, Yan Chen Wongworawat, Amir Abdipour, Sayna Norouzi
{"title":"Idiopathic Nodular Glomerulosclerosis in a Long-term Passive Smoker With Recently Diagnosed Hypertension: A Case Report.","authors":"Mehrbod Vakhshoori, Paul E Hanna, Zainab Obaidi, Yan Chen Wongworawat, Amir Abdipour, Sayna Norouzi","doi":"10.1177/23247096251323066","DOIUrl":"10.1177/23247096251323066","url":null,"abstract":"<p><p>Idiopathic nodular glomerulosclerosis (ING) is mostly associated with long-standing active smoking and hypertension (HTN). Herein, we present a rare case of ING in a passive smoker with recently diagnosed uncontrolled HTN. A 60-year-old white female with Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, Skin changes (POEMS) syndrome and newly diagnosed HTN was referred because of an elevated creatinine level. She denied being an active smoker but reported long-term exposure to cigarette smoke due to living with a heavy smoking family and working as a bartender. Further investigations revealed microscopic hematuria and nephritic range proteinuria. Kidney biopsy revealed diffuse and focal nodular mesangial expansion without hypercellularity, with negative staining for amyloid, fibrillary glomerulonephritis, and immunoglobulins, leading to a diagnosis of ING. This case highlights a rare case of ING secondary to heavy passive smoking and uncontrolled HTN.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251323066"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dust to Disease: Cavitary Lung Lesion With <i>Mycobacterium kansasii</i> in a Black Lung Patient.","authors":"Naga Vamsi Krishna Machineni, Dedeepya Gullapalli, Shivendra Tangutoori, Anusha Tipparthi, Simmy Lahori, Fares Khater, Subramanya Shyam Ganti","doi":"10.1177/23247096251348906","DOIUrl":"10.1177/23247096251348906","url":null,"abstract":"<p><p><i>Mycobacterium kansasii</i> is a slow-growing mycobacterium commonly affecting the lungs, usually in a structurally deformed lung. We discuss a case of 67-year-old male with a medical history of complicated coal workers pneumoconiosis or coal mine dust lung disease presented to the pulmonary clinic with worsening dyspnea and hemoptysis with imaging findings revealing cavitary lung lesions in the right upper lobe and progressive massive fibrosis (PMF) bilaterally. Patient sputum gram stain showed acid-fast bacilli, and the cultures grew <i>M. kansasii</i>. He was started on rifampin, ethambutol, and azithromycin. This case highlights the importance of thorough workup of cavitary lung lesion, reinforcing the association of mycobacterium species in a patient with PMF and associated cavities.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251348906"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lefika Bathobakae, Jorge L Lopez Cuello, Rammy Bashir, Heba Farhan, Irhoboudu D Atogwe, Yana Cavanagh
{"title":"Blastoid Mantle Cell Lymphoma Presenting as an Isolated Cecal Mass.","authors":"Lefika Bathobakae, Jorge L Lopez Cuello, Rammy Bashir, Heba Farhan, Irhoboudu D Atogwe, Yana Cavanagh","doi":"10.1177/23247096251325401","DOIUrl":"10.1177/23247096251325401","url":null,"abstract":"<p><p>Blastoid mantle cell lymphoma (B-MCL) is a rare and aggressive subtype of B-cell non-Hodgkin lymphoma characterized by a high proliferation index and poor prognosis. Gastrointestinal (GI) involvement, which is common in systemic mantle cell lymphoma (MCL), rarely presents as an isolated lesion. Herein, we describe a unique case of B-MCL presenting as an isolated cecal mass. The patient experienced acute-onset abdominal pain and melena and was found to have cecal wall thickening on imaging, with regional lymphadenopathy. Colonoscopy revealed a large ulcerated polypoid lesion in the cecum, and histopathology confirmed the diagnosis of B-MCL. The patient completed 4 cycles of bendamustine/rituximab regimen but was terminally extubated due to clinical deterioration. Although infrequent, MCL should be considered in the differential diagnosis of isolated GI masses. This case adds to the limited literature on B-MCL, which could potentially help with the formulation of diagnostic and treatment algorithms for this rare pathology.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251325401"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shengmin Huang, Muhammad Tahir, Gardith Joseph, Richrd Wu, Jaron Tepper, Jen C Wang
{"title":"HE-4 in the Diagnosis of Carcinoma of Ovary Presented as Unknown primary Carcinoma: A Case Report.","authors":"Shengmin Huang, Muhammad Tahir, Gardith Joseph, Richrd Wu, Jaron Tepper, Jen C Wang","doi":"10.1177/23247096251344701","DOIUrl":"10.1177/23247096251344701","url":null,"abstract":"<p><p>Ovarian cancer is the second most common gynecologic malignancy in the United States, with high mortality due to delayed diagnosis. Serum CA-125 is widely used for screening and monitoring but lacks sensitivity and specificity in some cases. We present a 67-year-old female diagnosed with advanced-stage ovarian cancer despite normal CA-125 levels, with elevated HE4 (human epididymis protein 4), underscoring its diagnostic value. This case highlights the importance of integrating HE4 with CA-125 in ovarian cancer evaluation and emphasizes a multimodal approach to enhance early detection and outcomes.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251344701"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariel Ahl, Harendra Ipalawatte, Saif Ghias, Arian Gower
{"title":"A Rare Case of Scleroderma Renal Crisis.","authors":"Ariel Ahl, Harendra Ipalawatte, Saif Ghias, Arian Gower","doi":"10.1177/23247096251336565","DOIUrl":"https://doi.org/10.1177/23247096251336565","url":null,"abstract":"<p><p>Scleroderma renal crisis is a rare, life-threatening complication of systemic sclerosis. It is characterized by pronounced hypertension, acute kidney injury, and thrombotic microangiopathy. Although its prevalence has decreased over the last decade, and death rates have declined since the introduction of treatment with Angiotensin converting enzyme (ACE)-inhibitors, it remains a challenge due to lack of prevention and rapid progression despite intervention in those who develop renal crisis. We present a 46-year-old female with history of rheumatoid arthritis and scleroderma who presented to the Emergency Department (ED) with complaints of a severe headache associated with nausea and vomiting that started earlier in the day. Patient presented with a blood pressure of 180/103 that did not improve with use of anti-hypertensive medications. Labs were remarkable for anemia and decreased renal function. A CT of the abdomen and pelvis without contrast demonstrated distention of distal esophagus with possible underlying esophageal dysmotility due to degree of distention and dependent areas of tractional bronchiectasis in the bilateral lower lobes that can be seen in the setting of early interstitial lung disease. Treatment with an ACE-inhibitor was initiated, with improvement in blood pressure and resolution of headache. This case demonstrates another rare case and illustrates the importance of rapid recognition and treatment.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251336565"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priya Ramcharan, Arun Katwaroo, Matthew Maharaj, Valmiki Seecheran, Dayna Lalchansingh, Rajeev Seecheran, Shari Khan, Naveen Seecheran
{"title":"Giant Right Atrial Myxoma Presenting With Right Heart Failure.","authors":"Priya Ramcharan, Arun Katwaroo, Matthew Maharaj, Valmiki Seecheran, Dayna Lalchansingh, Rajeev Seecheran, Shari Khan, Naveen Seecheran","doi":"10.1177/23247096251329706","DOIUrl":"10.1177/23247096251329706","url":null,"abstract":"<p><p>Right atrial myxomas (RAMs) are exceedingly rare cardiac tumors that can incur devastating complications. These tumors are capable of producing right-sided heart failure (rHF) through obstruction of venous return and tricuspid inflow. Herein, we describe a 52-year-old woman presenting with classic symptomatology of rHF as clinical sequelae of a giant RAM. The clinician should be cognizant of RAMs as an atypical etiology of rHF, and the complementary imaging modalities in the diagnostic work-up and early surgical resection as key management strategies.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251329706"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dre E Steinwehr, Jena M Gales, Anya R de Leeuw, Derek S Anderson, Christopher R Cunningham, Aaron A H Smith
{"title":"Biopsy Confirmed Skin Drug Eruption in Setting of Ticagrelor Use.","authors":"Dre E Steinwehr, Jena M Gales, Anya R de Leeuw, Derek S Anderson, Christopher R Cunningham, Aaron A H Smith","doi":"10.1177/23247096251350547","DOIUrl":"10.1177/23247096251350547","url":null,"abstract":"<p><p>When there is concern that a rash may be a drug eruption reaction, there are many well-known culprits such as antibiotics and phenytoin. When an uncommon or previously unknown offending medication is being considered to have caused a drug eruption, diagnostic skin biopsy can help confirm the diagnosis. Our patient is a 54-year-old female with past medical history of prediabetes and obesity. She had ST segment-elevation myocardial infarction that was treated appropriately with timely percutaneous coronary intervention, which included angioplasty and drug-eluting stent placement. She was maintained on treatment regimen, and over the next 3 months, she developed a worsening maculopapular rash across her torso and upper extremities. Her biopsy showed superficial and mid-dermal perivascular lymphohistiocytic inflammation with focal spongiosis and scattered eosinophils, a common pathologic finding seen in drug eruptions. Although the patient was not taking any well-known offending agents, her ticagrelor was discontinued and she was transitioned to clopidogrel. Shortly after the transition, the patient's drug rash resolved without recurrence. Drug eruptions are a common etiology for rashes leading to presentation in primary care clinics. Our patient illustrates an exceedingly rare case of ticagrelor-induced drug reaction, as a review of the literature shows only 2 previously published case reports.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251350547"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}