Search

Case Presentation A 44-year-old man with hyperthyroidism and no smoking history presented to his internist with 5 months of intermittent cough and hemoptysis. The patient’s family history was remarkable only for non-Hodgkin’s lymphoma in his father. He had a history of a 25-day exposure to a home renovation at work 2 years prior to presentation. He was treated with oral clarithromycin with no improvement in his symptoms. A chest radiograph showed bilateral nodular opacities with a left lower lobar consolidative opacity ( Fig 1 A, 1 B); the patient underwent CT scanning of the chest, which showed areas of nodular infiltration in the lower lobes with tree-in-bud-like opacities. He was referred to a pulmonologist.

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis characterized by small to medium size vessel vasculitis. Here, we present a case of newly diagnosed EGPA presenting as non-ST segment elevation myocardial infarction (NSTEMI). Case: A 53-year-old male with a history of asthma and nasal polyps presented with acute onset anginal chest pain, rising troponin T and CKMB without ischemic changes on electrocardiogram. He was admitted for NSTEMI. Cardiac catheterization showed non-obstructive coronary artery disease (Figure 1). Given his past medical history along with eosinophilia and pulmonary opacities seen on CT chest, there was concern for EGPA. Lung wedge resection biopsy showed parenchymal eosinophilia, granulomatous inflammation, and vasculitis that confirmed the diagnosis (Figure 2). Figure 1 Figure 2 Discussion: Cardiac involvement is known to be a major contributor to disease-related death, totaling up to 50% of cases, and therefore poses an important aspect of this rare disease. Recent reports, particularly concerning clinical differences given ANCA status, have shown that these patients might represent a heterogeneous group. For instance, ANCA-negative patients, such as our patient, more frequently develop heart conditions. We cultivate such discussion not only to bring attention to EGPA as an uncommon entity to the practice of many cardiologists, but also to point out that early recognition of cardiac involvement could reduce morbidity and mortality.

We present the management of 2 cases of post-trabeculectomy flat anterior chamber with hypotony due to an overflowing fistula. When separate attempts to reform the anterior chamber by intracameral injection of sulfur hexafluoride (SF 6 ) and sodium hyaluronate 1.0% (Healon®) failed, we injected SF 6 100% with Healon into the anterior chamber. This stabilized the anterior chamber without compromising the integrity of the filtering bleb. No complications were observed. This simple, safe, and effective procedure offers another option for the management of a flat anterior chamber due to overfiltration.

Prickly pear fruit rectal seed bezoars are an extremely rare entity. Only nine cases of rectal seed bezoar have been reported, only one of which involved the prickly pear fruit seed. Furthermore, to our knowledge, this is also the first reported case presenting as rectal perforation.We report a case of prickly pear fruit bezoar occurring in the elderly whom presented with rectal perforation. Consistent with physical signs, laboratory results, and radiological findings the patient was diagnosed with acute perforation of the rectum. A Hartman procedure was performed, and a colostomy was placed.Currently there are very few data regarding seed bezoars reaching the rectum. There are even fewer data concerning this occurrence in the elderly, and the literature contains no report of this phenomenon presenting or even progressing into perforation. We report this rare entity to the existing literature.We report a rare but important case. A prickly pear fruit phytobezoar presenting as rectal perforation. This case may add to the increasing awareness of the danger associated with ingestion of certain foodstuffs. The previously benign sunflower and psyllium seeds are now known to cause bezoar. We feel that the prickly pear fruit should join this small but important list.