GASTRIC XANTHELASMA Roxanne Nemati MD, Meredith Hickman MD, Conar Fitton MD; Department of Medicine, Leonard J. Chabert Medical Center, Houma LA.
Introduction: Gastric xanthelasmas have been reported in association with diabetes, dyslipidemia, and Helicobacter pylori infection and are rare endoscopy findings. Though they are benign, they may mimic gastric malignancies or be found in association with premalignant conditions. It is therefore important to identify and confirm these lesions via histopathology. Case: A 46-year-old male with hidradenitis suppurativa, type 2 diabetes, and gastresophageal reflux disease presented with intermittent epigastric pain, previously alleviated with use of Pepcid PRN, but recently worsening with accompanying dyspepsia. He denied any alcohol use but endorsed recent initiation of NSAID use (diclofenac 75 mg BID). He described the pain as gnawing in nature with radiation to the left lower quadrant. He also endorsed occasional nausea worse with eating, resulting in decreased oral intake. Physical exam and laboratory findings including lipid panel were unremarkable. Abdominal imaging revealed fatty liver without any other abnormalities. He underwent esophagogastroduodenoscopy, which revealed a single 6 mm sessile polyp in the
gastric body and erythematous mucosa in the stomach. Biopsy of the gastric nodule revealed foamy macrophages consistent with xanthelasma. H. pylori stain was negative and there was no evidence of malignancy. Biopsy of the gastric mucosa showed mild chronic gastritis. He endorsed relief of symptoms with initiation of proton pump inhibitor. Discussion: Gastric xanthalasmas are rare findings with an incidence of <1%. They are characterized histologically by the presence of foamy macrophages and can be found in the upper gastrointestinal tract. They are most commonly found in the gastric antrum and/or pylorus. They often occur in concert with chronic gastritis. Though xanthelasmas are associated with premalignant conditions (atrophic gastritis, gastric dysplasia, etc.), it has been suggested that xanthelasmas may be the result of normal aging. However, histological confirmation is mandatory as they have been associated with H. pylori infection or mimic gastrointestinal malignancies (carcinoid tumors, signet cell carcinoma). Follow up is indicated if there is high suspicion for malignancy.
MELIODOSIS PRESENTING AS URINARY TRACT INFECTION: A RARE PRESENTATION IN A NON-ENDEMIC REGION EMPHASIZING THE ROLE OF TRAVEL HISTORY Hamama Javaid, Sham Kumar, Usman Haq, Trisandhya Sharma, Mahesh Thapa, Imran Ali Khan; Department of Medicine, St Francis Medical Center, Monroe, LA.
Introduction: Melioidosis, caused by Burkholderia pseudomallei, is a serious tropical infection endemic in regions like Southeast Asia. We present a case in which the uncommon presentation of melioidosis as a urinary tract infection (UTI) is observed in a patient from a non-endemic area, emphasizing the importance of considering travel history in atypical cases. Case: A 71-year-old male with Type 2 Diabetes and Hypertension presented with complaints of polyuria, polydipsia, and an abrupt onset of urinary retention. Upon arrival, the patient was normotensive but tachycardic, and febrile up to 101°F. Notably, the patient experienced marked bladder distension, resulting in lower abdominal pain. After urinary catheterization, the patient voided 1800 ml of urine.
Laboratory results revealed elevated blood glucose (575 mg/dL), an anion gap of 17, and lactic acid at 2.0, indicating Diabetic Ketoacidosis (DKA). There was suspicion that an underlying Urinary Tract Infection (UTI) triggered the DKA due to the presence of leukocyte esterase, nitrites, and bacteria in the urine analysis. A computed tomography (CT) scan of the abdomen and pelvis disclosed bladder wall thickening and perivascular fat stranding, suggestive of cystitis. Consequently, the patient was admitted to the intensive care for DKA management. Before commencing empirical antibiotic treatment, both urine and blood cultures were obtained. The results from these cultures confirmed the presence of Burkholderia pseudomallei, indicating a melioidosis infection. Consequently, antibiotic therapy was adjusted, incorporating meropenem and Bactrim for 38
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