Uretero‐ileal fistula (UIF) is an exceedingly rare subtype of uretero‐enteric fistula, predominantly arising secondary to inflammatory bowel disease, pelvic radiotherapy, and iatrogenic injuries. Clinical manifestations are heterogeneous: most patients present with predominant urinary tract symptoms, while intestinal manifestations as the chief complaint remain uncommon. We herein report a case of a 55‐year‐old female with bilateral radiation‐induced ureteral strictures, complicated by anuria and refractory high‐volume watery diarrhea as the leading clinical manifestations. A definitive diagnosis of UIF was confirmed by anterograde urography. The patient received combined interdisciplinary surgery performed collaboratively by gastroenterological and urological surgical teams, with complete resolution of all clinical symptoms postoperatively. This atypical case indicates that UIF should be included in the differential diagnosis for patients presenting intractable diarrhea concurrent with urinary tract dysfunction, particularly those with a history of pelvic radiotherapy and chronic indwelling double‐J ureteral stents.
Background Venlafaxine toxicity can cause symptoms ranging from central nervous system effects (e.g., dizziness and loss of consciousness) to cardiovascular manifestations (e.g., QTc prolongation and tachycardia). It is complicated by serotonin syndrome, which can present with high fever, sweating and rigid muscles. The incidence of death from venlafaxine is 12.7 deaths per million prescriptions (Vo et al.; 2020). Case Presentation We describe a 40‐year‐old female who took a significant overdose of 15 g of venlafaxine and presented with profound shock. Management of this patient was challenging. She was initially started on the usual vasopressor agents, such as noradrenaline and vasopressin. In addition, sodium bicarbonate was administered because of the tricyclic antidepressant effect of venlafaxine with large ingestions (Galust et al.; 2024). Her shock was refractory to all these modalities. Hence, high‐dose insulin euglycemic therapy was initiated, and she was bridged to VA‐ECMO. Conclusion We report the first case in which high‐dose insulin therapy was used as a bridge to VA‐ECMO. There have been four other case reports with similar large doses of 15 g of venlafaxine or above.
Parvimonas micra (P. micra) is a Gram-positive anaerobic coccus and a well-recognized important oral pathogen, most closely associated with periodontal lesions, periapical abscesses, and periodontitis. Reports of empyema caused by this organism are rare, with only a few case reports published to date. We herein report a 62-year-old male patient who presented with persistent dull chest pain in the left hypochondriac region for 2 weeks without obvious predisposing causes. Gram-positive cocci were observed in the pleural effusion smear, and the culture yielded positive growth under anaerobic conditions after 48.6 h. The isolate was identified as P. micra by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Based on the medical history, imaging findings, and etiological examination of pleural effusion, the patient was diagnosed with encapsulated empyema due to P. micra infection. After anti-infective treatment with meropenem combined with ornidazole and pleural effusion drainage, the patient improved and was discharged.
Immunoglobulin G4–related disease (IgG4-RD) is a chronic fibroinflammatory disorder affecting multiple organs, including the kidneys. Ulcerative colitis (UC) is an immune-mediated colonic disease. Their coexistence is uncommon, especially when UC is not IgG4 associated. We report a 38-year-old male with an 8 year UC history in remission on mesalazine, who presented with elevated serum creatinine (165 µmol/L) and enlarged kidneys (right 15.5 cm and left 16.7 cm). Laboratory tests showed markedly elevated serum IgG4 (45.1 g/L) and IgE (376.5 KIU/L). Kidney biopsy revealed diffuse IgG and IgG4 positivity in the renal interstitium with a G4/G ratio > 40%, confirming IgG4-related tubulointerstitial nephritis (IgG4-TIN). Prior and current colon biopsies showed no significant IgG4+ plasma cells (IgG4/IgG < 10%), excluding IgG4-related enteropathy. The patient received methylprednisolone 24 mg/day. After 6 months, serum creatinine fell to 99 µmol/L, kidney size normalized (12.0 cm bilaterally), and serum IgG4 dropped to 2.8 g/L. This case highlights that IgG4-TIN with prominent renal enlargement and mild renal dysfunction can coexist with non-IgG4-related UC and low-dose methylprednisolone was effective and well tolerated.
This article presents a clinical case of successful surgical treatment of a young patient with congenital BAV complicated by the development of a sinus of Valsalva aneurysm (SoVA). The aneurysm was associated with marked compression of the right atrium, which may have contributed to atrial structural remodeling and provided a potential substrate for atrial flutter. The reduced left ventricular ejection fraction was considered potentially related to tachycardia-induced cardiomyopathy. Notably, despite the severity of the underlying pathology, the patient’s clinical presentation was limited to frequent palpitations and pronounced weakness.
