Cardiac sarcoidosis is a rare immunologically driven process seen in 2% to 5% of patients with systemic sarcoidosis. We present a 31-year-old woman who presented after a ventricular fibrillation cardiac arrest. A comprehensive diagnostic workup was unrevealing. Despite negative cardiac magnetic resonance imaging, positron emission tomography facilitated the diagnosis. This case illustrates both the limitations of the diagnostic workup of sarcoidosis and the usefulness of positron emission tomography in the early diagnosis of cardiac sarcoidosis.Thrombocytopenia has many mechanisms with broad differentials. A detailed history and physical, with timely diagnostic testing, is necessary to parse out the underlying etiology. Clinicians should maintain a high suspicion for drug-induced thrombocytopenia when there is an acute drop in the platelet level after exposure to commonly implicated drugs. Drug-induced thrombocytopenia is not well defined, as reporting is voluntary and not critically reviewed. Oftentimes, the culprit is not the drug itself, but a drug metabolite, which is difficult to prove with drug-dependent antibody testing. Here we present a case where naproxen led to hemarthrosis secondary to drug-induced thrombocytopenia.Sarcoidosis and lymphoma are two separate entities that need to be considered in the differential diagnosis of lymphadenopathy. Rarely these two diseases may coexist, in which case there may arise a diagnostic challenge, especially when the available sample is limited. We report a case of occult mantle cell lymphoma arising in an individual with a long history of sarcoidosis.On rare occasions, a promonocyte may be difficult to morphologically distinguish from a promyelocyte, giving rise to the diagnosis of acute promyelocytic leukemia, particularly the microgranular variant. It is necessary to correctly diagnose these two types of leukemia, as treatment is different for each. Flow cytometry and cytogenetic/molecular studies are useful in distinguishing the two when morphology alone is equivocal. We report a case of acute monocytic leukemia in which the promonocytes morphologically masqueraded as promyelocytes.Angiomyolipomas are benign tumors composed of blood vessels, adipose tissue, and smooth muscle. Usually, these lesions are located in the kidney and are found in association with tuberous sclerosis. The current case describes the rare presence of an angiomyolipoma within the nasal vestibule, leading to nasal obstruction. Surgical resection of the lesion was curative, and the patient's nasal congestion improved postoperatively. Consistent with previous findings in the literature, the patient's angiomyolipoma had not recurred at subsequent postoperative visits.Vasoactive intestinal peptide (VIP)-secreting neuroendocrine tumors are an exceptionally rare cause of chronic diarrhea. We describe a 36-year-old woman presenting with a 2-year history of severe diarrhea and electrolyte derangements ultimately diagnosed with VIPoma.Double pylorus is an uncommon clinical condition that can be acquired or congenital. Most acquired cases arise as a complication of peptic ulcer disease and less commonly from other conditions such as gastric malignancy. #link# We present a case of double pylorus in a cirrhotic patient diagnosed during surveillance endoscopy for esophageal varices.Histiocytoid Sweet's syndrome (HSS) is a rare variant of Sweet's syndrome that typically has similar clinical findings to the classic variant but is diagnosed after histologic review. It is characterized by a dermal infiltrate composed of immature, nonblastic myeloid cells with a histiocytic appearance. In this report, we present a case of a 56-year-old Hispanic man with history of stage IIIB adenocarcinoma of the colon who presented with a case of HSS that mimicked a zosteriform cutaneous metastasis. Several types of cancers can metastasize to the skin, leading to varying cutaneous presentations. In particular, a zosteriform dermatomal distribution of cutaneous metastasis is common in melanoma and has been reported in other cancers, such as colon and breast. To our knowledge, this is the first case in which the clinical presentation of HSS appeared in a zosteriform pattern and distribution.Bariatric surgery has become an accepted and effective treatment for morbid obesity. Laparoscopic sleeve gastrectomy is the most common weight loss procedure, in which patients on average lose 60% of their excess body weight. Recently, a completely endoscopic approach was developed that takes advantage of an endoscopic suturing device to plicate the greater curvature of the stomach into sleeve-like anatomy. The endoscopic sleeve gastroplasty has been shown to be safe with minimal complications and good weight loss outcomes. We present a case of a rare and dangerous complication of endoscopic sleeve gastroplasty that required emergent surgical intervention.A Dieulafoy lesion is a dilated, submucosal artery that can erode through the adjacent gastrointestinal mucosa, resulting in spontaneous rupture and massive gastrointestinal bleeding. If misdiagnosed or left untreated, these lesions have up to an 80% mortality rate. Here we present the case of a 70-year-old woman with abdominal pain who was found to have a submucosal gastric vascular structure on computed tomography angiography of the pulmonary arteries. She underwent outpatient esophagogastroduodenoscopy to confirm the presence of a gastric Dieulafoy lesion and was successfully treated with mesenteric angiography and transarterial embolization.Bouveret syndrome is the rarest variant of gallstone ileus, with a high morbidity and mortality rate as well as life-threatening complications. We present a case of an 86-year-old woman who presented with abdominal pain and was diagnosed with acute cholecystitis. After laparoscopic cholecystectomy, her symptoms did not improve. She then underwent endoscopic retrograde cholangiopancreatography and was found to have a stone causing duodenal bulb obstruction. The stone was removed using a snare, and her symptoms improved greatly. This rare case of Bouveret syndrome with no apparent fistula was successfully treated using endoscopic measures.
Cardiac sarcoidosis is a rare immunologically driven process seen in 2% to 5% of patients with systemic sarcoidosis. We present a 31-year-old woman who presented after a ventricular fibrillation cardiac arrest. A comprehensive diagnostic workup was unrevealing. Despite negative cardiac magnetic resonance imaging, positron emission tomography facilitated the diagnosis. This case illustrates both the limitations of the diagnostic workup of sarcoidosis and the usefulness of positron emission tomography in the early diagnosis of cardiac sarcoidosis.Thrombocytopenia has many mechanisms with broad differentials. A detailed history and physical, with timely diagnostic testing, is necessary to parse out the underlying etiology. Clinicians should maintain a high suspicion for drug-induced thrombocytopenia when there is an acute drop in the platelet level after exposure to commonly implicated drugs. Drug-induced thrombocytopenia is not well defined, as reporting is voluntary and not critically reviewed. Oftentimes, the culprit is not the drug itself, but a drug metabolite, which is difficult to prove with drug-dependent antibody testing. Here we present a case where naproxen led to hemarthrosis secondary to drug-induced thrombocytopenia.Sarcoidosis and lymphoma are two separate entities that need to be considered in the differential diagnosis of lymphadenopathy. Rarely these two diseases may coexist, in which case there may arise a diagnostic challenge, especially when the available sample is limited. We report a case of occult mantle cell lymphoma arising in an individual with a long history of sarcoidosis.On rare occasions, a promonocyte may be difficult to morphologically distinguish from a promyelocyte, giving rise to the diagnosis of acute promyelocytic leukemia, particularly the microgranular variant. It is necessary to correctly diagnose these two types of leukemia, as treatment is different for each. Flow cytometry and cytogenetic/molecular studies are useful in distinguishing the two when morphology alone is equivocal. We report a case of acute monocytic leukemia in which the promonocytes morphologically masqueraded as promyelocytes.Angiomyolipomas are benign tumors composed of blood vessels, adipose tissue, and smooth muscle. Usually, these lesions are located in the kidney and are found in association with tuberous sclerosis. The current case describes the rare presence of an angiomyolipoma within the nasal vestibule, leading to nasal obstruction. Surgical resection of the lesion was curative, and the patient's nasal congestion improved postoperatively. Consistent with previous findings in the literature, the patient's angiomyolipoma had not recurred at subsequent postoperative visits.Vasoactive intestinal peptide (VIP)-secreting neuroendocrine tumors are an exceptionally rare cause of chronic diarrhea. We describe a 36-year-old woman presenting with a 2-year history of severe diarrhea and electrolyte derangements ultimately diagnosed with VIPoma.Double pylorus is an uncommon clinical condition that can be acquired or congenital. Most acquired cases arise as a complication of peptic ulcer disease and less commonly from other conditions such as gastric malignancy. #link# We present a case of double pylorus in a cirrhotic patient diagnosed during surveillance endoscopy for esophageal varices.Histiocytoid Sweet's syndrome (HSS) is a rare variant of Sweet's syndrome that typically has similar clinical findings to the classic variant but is diagnosed after histologic review. It is characterized by a dermal infiltrate composed of immature, nonblastic myeloid cells with a histiocytic appearance. In this report, we present a case of a 56-year-old Hispanic man with history of stage IIIB adenocarcinoma of the colon who presented with a case of HSS that mimicked a zosteriform cutaneous metastasis. Several types of cancers can metastasize to the skin, leading to varying cutaneous presentations. In particular, a zosteriform dermatomal distribution of cutaneous metastasis is common in melanoma and has been reported in other cancers, such as colon and breast. To our knowledge, this is the first case in which the clinical presentation of HSS appeared in a zosteriform pattern and distribution.Bariatric surgery has become an accepted and effective treatment for morbid obesity. Laparoscopic sleeve gastrectomy is the most common weight loss procedure, in which patients on average lose 60% of their excess body weight. Recently, a completely endoscopic approach was developed that takes advantage of an endoscopic suturing device to plicate the greater curvature of the stomach into sleeve-like anatomy. The endoscopic sleeve gastroplasty has been shown to be safe with minimal complications and good weight loss outcomes. We present a case of a rare and dangerous complication of endoscopic sleeve gastroplasty that required emergent surgical intervention.A Dieulafoy lesion is a dilated, submucosal artery that can erode through the adjacent gastrointestinal mucosa, resulting in spontaneous rupture and massive gastrointestinal bleeding. If misdiagnosed or left untreated, these lesions have up to an 80% mortality rate. Here we present the case of a 70-year-old woman with abdominal pain who was found to have a submucosal gastric vascular structure on computed tomography angiography of the pulmonary arteries. She underwent outpatient esophagogastroduodenoscopy to confirm the presence of a gastric Dieulafoy lesion and was successfully treated with mesenteric angiography and transarterial embolization.Bouveret syndrome is the rarest variant of gallstone ileus, with a high morbidity and mortality rate as well as life-threatening complications. We present a case of an 86-year-old woman who presented with abdominal pain and was diagnosed with acute cholecystitis. After laparoscopic cholecystectomy, her symptoms did not improve. She then underwent endoscopic retrograde cholangiopancreatography and was found to have a stone causing duodenal bulb obstruction. The stone was removed using a snare, and her symptoms improved greatly. This rare case of Bouveret syndrome with no apparent fistula was successfully treated using endoscopic measures.