Congenital emphysema is a rare congenital disease which typically manifests in infants and newborns. Even more unusual is detection in later adult life though this has been reported.

Autoimmune Polyendocrine Syndromes (APS) are rare autoimmune endocrinopathies, characterized by the association of two or more organ-specific disorders. Type II Autoimmune Polyendocrine Syndromes (APS II) comprises the association of Addison’s disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. Although the classic presentation is symptomatic hypotension, it can manifest as an adrenal crisis - a life-threatening condition. We report a case of a 41-year-old woman with prolonged asthenia, cutaneous hyperpigmentation and symptomatic hypotension refractory to intravenous fluids. APS II was diagnosed with a presentation of an Addisonian crisis, resolved after the onset of hydrocortisone.

Spur cells are reportedly linked to advanced end-stage liver diseases and may lead to accelerated hemolysis. In this case report, we discuss one of these rare instances when a 45-year-old female with decompensated cirrhosis was admitted for severe anemia. Extensive workup revealed non-immune hemolysis secondary to spur cell formation. Orthotopic liver transplantation remains the only treatment of choice for reversal of spur cell anemia. Alternatively, multidrug therapy has also been explored, including usage of bile acid sequestrants; however, success is rare.

Electronic Nicotine Delivery Systems (ENDS) aerosolize cannabis oils, nicotine, and other chemicals by heating alcohols and flavorants in order to produce a vapor for inhalation. With the rise in popularity of these devices, there is a rapidly growing number of life-threatening electronic-cigarettes, or vaping-associated lung injury (EVALI) cases throughout the country. Among the EVALI cases, similarities of presentation, symptoms, respiratory complications, and effective treatments have been reported, but the pathologic mechanisms of injury seem to vary by case. We report a series of two patients presenting with clinical symptoms and imaging findings consistent with vaping-associated lung injury in the setting of heavy nicotine and tetrahydrocannabinol (THC) vaping. The first case is a 19-year-old Caucasian male admitted to the hospital with dyspnea, nausea, emesis, weight loss, and early signs of acute respiratory distress syndrome. The second case is a 24-year-old Caucasian male who presented to the emergency room with a productive cough, fever, myalgias, and tachycardia. Both patients were initially treated as typical cases of community-acquired pneumonia without clinical improvement. After being discharged, the patient from case 2 was readmitted with new onset emesis and worsening dyspnea. Utilizing extensive laboratory testing, chest imaging, bronchoscopy, and lung biopsy, we established a diagnosis of EVALI in both cases. Both patients did well after appropriate treatment with intravenous steroids and empiric antibiotics. Despite the similarities among clinical presentations, discrepancies in the literature exist regarding the clinical outcomes and pathophysiology of EVALI. These case-by-case variations may result from differences in time to diagnosis, temporal factors in amount and timing of vape use, and the chemical composition of the products vaped. Our case reports highlight the increasing need for clinical awareness of EVALI, improved diagnostic tools for a timely diagnosis, and effective treatments of this potentially fatal respiratory illness.

The aim of the present case report is to stress out the occurrence of hepatic infraction in pregnant women with antiphospholipid syndrome (APS) and the critical role magnetic resonance imaging (MRI) plays for the early diagnosis of rare complications of the disease. Here we report the case of a preeclamptic pregnant woman with APS in her 17th week of gestation, who experienced severe epigastric pain, followed by multiple episodes of vomiting and an episode of soft stools. Patient was submitted to MRI examination of the upper abdomen, where findings suggested hepatic infarction with subsequent deterioration of her general status. Therefore, she underwent termination of gestation. We conclude that pregnancy is a deteriorating factor of the disease and patient should be closely monitored, evaluated of any suspicious symptom or sign.

Capnocytophaga canimorsus is a commensal in the normal gingival flora of canine and feline species and is reported to cause infections in humans following bites by these species with potentially serious consequences, especially in the immunocompromised. Here we report a case of a 58-year-old healthy woman presenting with uncomplicated meningitis following a seemingly minor bite by her pet dog. With early detection and appropriate antibiotic therapy she had an uneventful recovery. Our case reports the possibility of this organism infecting an otherwise healthy, immunocompetent adult and the importance of being vigilant of such rare presentations by clinicians which will help to deliver appropriate therapy early to avoid any serious complications.