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  Drug Induced Liver Injury: A Case of Amoxicillin-Clavulanate-Induced Liver Injury

  Amira Al-Nabolsi, Barbara Senger, Hassan Eidy, Rami Dali, Mohmaed Musheinesh, and Ashbita Pokharel

  Publication Date: 10-27-2024

  Drug induced liver injury (DILI) is the most common cause of acute liver failure.

  Common causes include antibiotics, supplements, anti-inflammatory agents.

  Diagnosis is typically one of exclusion and usually does not require liver biopsy.

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  More Than You Can Swallow: Mycotic Aneurysm, An Uncommon Etiology of Dyspepsia

  Hussein Bazzy, Katharine Glover, Steven Jones, James Aldridge, Michael Potes, and Katie Sumnicht

  Publication Date: 5-9-2024

  Dyspepsia is defined as predominant epigastric pain lasting greater than one month.

  Common etiologies of dyspepsia include peptic ulcer disease, medications, and gastroesophageal reflux.

  We present a rare case of dyspepsia caused by a mycotic aneurysm due to accidental foreign body ingestion leading to emergent inpatient intervention.

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  Feeling Something Deeper: A Case of Hyalinizing Clear Cell Carcinoma of Lung Primary With Suspected Lynch Syndrome

  Hussein Bazzy, Cameron Hubbard, Ahmad Tahawi, Narayana Gandham, Richard Zekman, Phillip V. Kaplan, Erich J. Schwartz, and Kevin Jamil

  Publication Date: 5-22-2024

  Hyalinizing Clear Cell Carcinoma (HCCC) is a type of Salivary Gland-type Tumor (SGT) that can present as a rare subset of lung neoplasms1

  The association of HCCC with loss of mismatch repair expression (MMR) has not yet been described.

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  Atypical Presentation of Legionnaires' Disease

  Hassan Eidy, Barbara Senger, Joshua Steele, and Jolian Kathawa

  Publication Date: 5-9-2024

  Legionnaires’ disease or Legionellosis is a subtype of pneumonia caused by the gram negative bacilli, Legionella pneumophila.

  L. pneumophila serogroup 1 accounts for 50-80% of Legionnaires’ disease. ▪ Patients commonly present with fevers, chills, myalgia, cough and less commonly with confusion, nausea, vomiting, diarrhea, and/or anorexia.

  Treatment primarily consists of antibiotics with supportive measures. ▪ Renal and hepatic extrapulmonary manifestations from Legionella are rare, and often present with multisystem involvement when they do occur.

  This case highlights a unique, and rare, presentation of Legionnaires’ disease mimicking alcoholic hepatitis with 2:1 AST/ALT transaminitis and physical exam findings.

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  A Bizarre Halloween: A Rare Etiology of Phytobezoar

  Catharine R. Glover, James Aldridge, and Tedd March

  Publication Date: 5-9-2024

  A phytobezoar is defined as the composition of indigestible food particles found in the GI tract, primarily composed of plant material, such as fibers and cellulose.

  Any individual may develop a phytobezoar, but those with altered gastrointestinal anatomy or decreased motility are at highest risk.

  They often present with nausea, vomiting, and/or symptoms of gastric outlet syndrome.

  Complications include ulcerations, bleeding, bowel obstruction, and/or perforation.

  Thus, complete removal is the ultimate treatment.

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  Pass, Hold or Hit: Evaluating the Clinical Utility of Inpatient Hemoccult Card Testing

  Jared Grodman, Michael Potes, and Mariquit Sendelbach

  Publication Date: 5-9-2024

  Fecal occult blood testing is recommended as an alternative to colonoscopy as part of the Tier 1 colorectal cancer screening approaches recommended by the U.S. Multi Society Task Force. However, there has been widespread use of this test administered to hospitalized patients for evaluation of anemia or suspected GI bleeding even though fecal occult blood testing has not been validated for these indications by national gastroenterology societies. Furthermore, several studies have demonstrated that fecal occult blood testing is seldom helpful in clinical management (Ip, van Rijn, Cuthbert) and in fact may prolong hospital stay as well as delay the decision to proceed with endoscopy (Narula). Alternatively, fecal occult blood testing is frequently performed in patients with overt GI bleeding or those with unexplained iron deficiency anemia (Narula, Sharma), which by themselves are indications for endoscopy and do not necessitate FOB testing. Due to these reasons, several institutions have evaluated the clinical utility and cost effectiveness for inpatient ordering of fecal occult blood testing and have completely removed the test from computerized order sets. Our aim is to evaluate the ordering patterns of fecal occult blood testing in our hospital system to see if there is any diagnostic or clinical value that is provided by this test.

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  Purr-Ils of the Liver: A Case of Mash Cirrhosis Complicated by Disseminated Pasteurella

  Joanna Henry, Alaa Abujame, Cameron Hubbard, Angela Shermetaro, James Hebden, Hussein Bazzy, Jared Grodman, Katie Sumnicht, and Christopher Cooley Cooley

  Publication Date: 5-9-2024

  Pasteurella Multicoda is a gram-negative coccobacillus that is commensal to mammals such as domesticated pets and transmitted to humans by scratches or bites. The extent of infection is often limited to soft tissue, bone, and joint.

  Disseminated infection by P. multicoda infrequently is typically associated with peritoneal dialysis.

  We present a case of disseminated P. multocida infection with bacteremia and peritonitis in a patient with NASH Cirrhosis.

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  Uncommon Presentation of Gastrointestinal Histoplasmosis in an Immunocompromised Patient

  Usha Kellampalli, Nathanial Bartosek, Alsadiq Al-Hillan, and Dariusz Lazarczyk

  Publication Date: 10-29-2024

  Histoplasmosis rarely involves the GI tract, with only < 1 % of all histoplasmosis cases.

  Most common sites of involvement are Colon or rectum.

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  Exploring Familial Links to Cholangiocarcinoma: Insights into Genetic Predisposition and Risk Factors

  Usha Kellampalli, Nathanial Bartosek, Mohammed Alkhero, and Laith H. Jamil

  Publication Date: 10-29-2024

  Cholangiocarcinoma is a rare aggressive malignancy that varies widely by geographic region and often reoccurs.

  While a family history of bile duct cancer can increase the risk of developing the disease, it is still considered low due to its rarity and lack of clear hereditary patterns.

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  Takotsubo Cardiomyopathy Resulting in Hypoxic Hepatitis

  Jamil Qarqash, Devon Pyykkonen, and Olga Brushaber

  Publication Date: 5-9-2024

  Elevated liver enzymes are frequently observed in hospital settings, requiring a high level of suspicion for shock liver. In this report, we present a rare case of shock liver induced by Takotsubo cardiomyopathy (TCM). After other common causes of aminotransferase levels exceeding 1000 U/L were excluded, the focus shifted to managing the patient’s hemodynamics. This approach resulted in significant improvement of transaminase levels back to normal.

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  A Rare Case of Radial Arteriovenous Formation After Transradial Cardiac Catheterization

  Barbara Senger, Hassan Eidy, Andrew Gray, and Robert Grodman

  Publication Date: 5-2024

  In the United States, more than one million cardiac catheterization procedures are performed each year for diagnostic and therapeutic purposes.

  Right heart catheterizations allow for direct measurement of right-sided cardiac and pulmonary hemodynamics while left heart catheterizations provide a diagnostic and therapeutic role in those with coronary artery disease.

  In 1989, Lucien Campeau proposed the use of a smaller caliber catheter to access the small radial artery as a way to reduce the rates of bleeding complications.

  Advantages of utilizing the transradial artery (TRA) approach over the transfemoral artery (TFA) approach include:

  – Improved patient quality-of life metrics.

  – Reduced major bleeding and access site complications.

  – Lower total hospital costs.

  Access-site complications including radial artery occlusion and arteriovenous fistula (AVF) formation from TRA are rare and usually of minimal clinical impact.

  AVF may present with pain and edema at the puncture site, a pulsatile thrill, and/or visible dilated superficial veins.

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  More Than You Can Swallow: Mycotic Aneurysm, An Uncommon Etiology of Dyspepsia

  Hussein Bazzy, Katharine Glover, Steven Jones, James Aldridge, Michael Potes, and Katie Sumnicht

  Publication Date: 5-4-2023

  Dyspepsia is defined as predominant epigastric pain lasting greater than one month.

  ▪ Common etiologies of dyspepsia include peptic ulcer disease, medications, and gastroesophageal reflux.

  ▪ We present a rare case of dyspepsia caused by a mycotic aneurysm due to accidental foreign body ingestion leading to emergent inpatient intervention.

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  Atypical Presentation of Legionnaires' Disease

  Hassan Eidy, Barbara Senger, Joshua Steele, and Jolian Kathawa

  Publication Date: 5-4-2023

  Legionnaires’ disease or Legionellosis is a subtype of pneumonia caused by the gram negative bacilli, Legionella pneumophila.

  L. pneumophila serogroup 1 accounts for 50-80% of Legionnaires’ disease.

  Patients commonly present with fevers, chills, myalgia, cough and less commonly with confusion, nausea, vomiting, diarrhea, and/or anorexia.

  Treatment primarily consists of antibiotics with supportive measures.

  Renal and hepatic extrapulmonary manifestations from Legionella are rare, and often present with multisystem involvement when they do occur.

  This case highlights a unique, and rare, presentation of Legionnaires’ disease mimicking alcoholic hepatitis with 2:1 AST/ALT transaminitis and physical exam findings.

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  A Bizarre Halloween: A Rare Etiology of Phytobezoar

  Katharine Glover, James Aldridge, Tedd March, Jared Grodman, and Jolian Kathawa

  Publication Date: 5-4-2023

  A phytobezoar is defined as the composition of indigestible food particles found in the GI tract, primarily composed of plant material, such as fibers and cellulose.

  Any individual may develop a phytobezoar, but those with altered gastrointestinal anatomy or decreased motility are at highest risk.

  They often present with nausea, vomiting, and/or symptoms of gastric outlet syndrome.

  Complications include ulcerations, bleeding, bowel obstruction, and/or perforation.

  Thus, complete removal is the ultimate treatment.

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  Pass, Hold or Hit: Evaluating the Clinical Utility of Inpatient Hemoccult Card Testing

  Jared Grodman, Michael Potes, and Mariquit Sendelbach

  Publication Date: 5-4-2023

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  Purr-Ils of the Liver: A Case of Mash Cirrhosis Complicated by Disseminated Pasteurella

  Joanna Henry, Alaa Abujame, Cameron Hubbard, Angela Shermetaro, James Hebden, Hussein Bazzy, Jared Grodman, Katie Sumnicht, and Christopher Cooley

  Publication Date: 5-4-2023

  Pasteurella Multicoda is a gram-negative coccobacillus that is commensal to mammals such as domesticated pets and transmitted to humans by scratches or bites. The extent of infection is often limited to soft tissue, bone, and joint.

  Disseminated infection by P. multicoda infrequently is typically associated with peritoneal dialysis.

  We present a case of disseminated P. multocida infection with bacteremia and peritonitis in a patient with NASH Cirrhosis

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  Gastric Polyps Leading to Occult Blood Loss

  Nishant Aggarwal, Rabin Neupane, and Ketan Rana

  Publication Date: 10-2022

  Introduction

  In patients presenting with iron deficiency anemia, blood loss must be considered as an etiology. This is especially important in patients who are planned to undergo invasive procedure or need to be on antiplatelets or anticoagulation.

  Discussion

  Gastric polyps are noted to be present in 6% of EGDs, and are mostly incidentally detected. Many gastric polyps have similar endoscopic appearances and some of them have malignant potential, hence histolopathology is important. Gastric hyperplastic polyps are strongly associated with inflammatory disorders such as chronic gastritis, H. pylori gastritis, and pernicious anemia.1 Other gastric polyps: – Fundic gland polyps – Adenomatous polyps: High malignant potential – Gastric neuroendocrine tumors – Inflammatory fibroid polyps

  Conclusion

  Occult blood loss must be considered in differential diagnosis for new onset iron deficiency anemia. Even though gastric polyps may be incidentally detected, histopathology is important to rule out malignancy.

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  Cap polyposis: an unusual cause of rectal bleeding in a young patient

  Inayat Gill, Nishant Aggarwal, Mitual Amin, and Atulkumar Patel

  Publication Date: 10-2022

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  Colonoscopy-Induced Transient Mobitz Type 1 Block

  Inayat Gill, Samiksha Pandey, and Atulkumar Patel

  Publication Date: 10-2022

  • Propofol is a commonly used anesthetic in endoscopic procedures. • It can prolong the AV conduction through vagal stimulation leading to AV block. • We report a unique case of a healthy female undergoing a routine screening colonoscopy who developed a Mobitz type I block, in which propofol was the sole agent used for sedation.

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  Gangliocytic Paraganglioma: incidental presentation of a rare gastrointestinal stromal tumor

  Claire Hamman and Mariquit Sendelbach

  Publication Date: 5-2022

  • Gangliocytic paraganglioma (GP) is an extremely rare gastrointestinal stromal tumor frequently found in the second portion of the duodenum1 . • GP can present as an obstructive process, in the setting of abdominal pain, gastrointestinal bleeding, or incidentally. • In this case, we describe an 80 year old female with finding of an incidental GP during endoscopic retrograde cholangiopancreatography

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  PEG Tube: Dealing With Transcolonic Misplacement

  Marko Kozyk, Kateryna Strubchevska, and Mihaela Batke

  Publication Date: 10-2022

  Introduction

  Percutaneous endoscopic gastrostomy (PEG) tube acts as the favorable route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition, generally beyond 4 weeks. As PEG tube provides direct percutaneous access to the stomach, another indication for PEG placement includes stomach decompression. PEG tube placement is a relatively safe procedure; however, complications sometimes occur.

  Discussion

  Complications of PEG: • Hemorrhage • Aspiration • Inflammation • Infections • Misplacement • Formation of fistulas Misplacement results from juxtaposition of the colon between the stomach and the skin during the PEG insertion, resulting in a feeding tube passing through the colon, usually the transverse colon, before being anchored in the stomach.

  Prevention of PEG-tube misplacement: • Adequate air insufflation of the stomach can help prevent this complication by displacing the colon away from the path of the PEG tube

  Management of PEG tube misplacement: • Surgical (in the presence of peritonitis) • Endoscopic (in the absence of peritonitis) • Percutaneous removal of the tube may result in stercoral peritonitis or colocutaneous fistula.

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  Endoscopic Management of Migrated Pancreatic Stent into Hepaticojejunostomy Causing Acute Pancreatitis

  Samiksha Pandey, Andrew Aneese, Shailesh Niroula, and Laith H. Jamil

  Publication Date: 10-2022

  • Trans-anastomotic pancreatic stents after the pancreatoduodenectomy are placed to decrease the complications, maintain ductal patency and support healing of the anastomosis. • Complications of migration of trans-anastomotic stent from the pancreatojejunostomy (PJ) through the hepaticojejunostomy (HJ) is rare. • We present a case of acute pancreatitis in the setting of pancreatic duct (PD) stent migration into the biliary tree in a patient who had previously undergone pancreaticoduodenectomy.

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  Gastrointestinal Kaposi Sarcoma: A Case Report

  Samiksha Pandey, Shailesh Niroula, Rabin Neupane, Gaurav Kakked, and Naveen Reddy

  Publication Date: 10-2022

  • Kaposi sarcoma (KS) in the gastrointestinal (GI) tract is an uncommon entity specially without any cutaneous manifestation since the introduction of HAART therapy in HIV patients. • Most of the gastrointestinal KS, remains undiagnosed as majority of KS is asymptomatic.(1) Here we present a case of GI- KS in a HIVAIDS patient.

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  Risk Factors of Clostridium Difficile Infection in Helicobacter Pylori Diagnosed Patients: A Multicenter Study

  Samiksha Pandey, Tamera Tennant, Ashbina Pokharel, Andrew Aneese, and Alexandra Halalau

  Publication Date: 10-2022

  • Clostridium difficile infection (CDI) is one of the most common gastrointestinal illnesses. • There are conflicting studies regarding the association of CDI with Helicobacter Pylori (H. pylori) treatment regimens.1-3 • Our aim is to investigate the risk of CDI in those treated for H. pylori as well as characterize other risk factors for developing CDI.