A 69-year-old man with irritable bowel syndrome on a restricted diet presented with fatigue, myalgias, extensive bilateral lower-extremity petechiae and ecchymoses, transfusion-refractory anemia, and elevated inflammatory markers. A low serum vitamin C level led to the diagnosis of scurvy. This is the first reported case of vitamin C deficiency and clinical scurvy related to voluntary dietary restriction from irritable bowel syndrome in an adult patient.Acute esophageal necrosis is a rare cause of gastrointestinal bleeding. Endoscopically, it appears as a circumferential black-appearing mucosa affecting almost universally the mid and distal esophagus. Risk factors include low flow states, malnutrition, alcoholism, and the presence of multiple comorbidities. Prolonged exposure to gastric secretions and direct contact with corrosive agents also induce mucosal ischemia. Sodium polystyrene sulfonate use has been associated with severe gastrointestinal adverse events, including increased risk of small bowel and colonic necrosis and perforation. In susceptible individuals, sodium polystyrene sulfonate can also induce esophageal ischemia and necrosis, as illustrated in this case.Recurring, exudative, lymphocytic-predominant pleural effusions have not been previously reported in association with walled-off pancreatic necrosis. We present a case of chronic pancreatitis complicated by a large pancreatic fluid collection and recurrent pleural effusion. Endoscopic drainage of the walled-off pancreatic necrosis was the definitive treatment for both fluid collections.In recent years, e-cigarette use has become more popular. Until recently, it was considered safer than smoking. We report two cases of acute pulmonary illness associated with vaping, focusing on their histologic patterns.Prior reports have associated the unusual presentations of anti-glomerular basement membrane (anti-GBM) disease and pulmonary aspergillosis in an immunocompetent host. We present the case of a previously healthy 24-year-old man who presented with symptoms of hemoptysis, cough, and dyspnea. His environmental risk factors included tobacco use (smoking), hydrocarbon exposure, and an unidentified mold present in his home. Laboratory evaluation revealed positive serum anti-GBM autoantibodies and positive detection of galactomannan in the bronchoalveolar lavage fluid. The diagnosis of anti-GBM disease was confirmed with a kidney biopsy. Management included therapy with voriconazole for aspergillosis and prednisone, plasmapheresis, and eventually cyclophosphamide for anti-GBM disease.We report a 50-year-old man with a possible stroke 3 months earlier, recurrent shingles outbreaks, and male-who-has-sex-with-men status who presented to the emergency department with worsening confusion, lower-extremity weakness, gait imbalance, and incontinence. Given his clinically immunocompromised state, the patient was started on intravenous acyclovir. A human immunodeficiency virus (HIV) test returned positive, magnetic resonance imaging of the brain showed a ring-enhancing lesion, and lumbar puncture was positive for varicella-zoster virus. Eventual brain biopsy of the ring-enhancing lesion confirmed vasculitis. This case highlights the broad differential of a ring-enhancing lesion and the importance of early HIV screening.This case describes a 60-year-old immunosuppressed man after renal transplant who presented to the emergency department with 1 week of generalized weakness, a 20-lb unintentional weight loss, sore throat, dysarthria, dysphagia, cough, and shortness of breath. Additionally, he developed tinnitus, headaches, photophobia, and neck stiffness. He underwent an extensive workup including a lumbar puncture with meningitis and encephalitis panel, which was positive for varicella zoster virus. He never developed a dermatomal vesicular rash but had persistent dysphagia and aspiration and was eventually diagnosed with Vernet syndrome. This case highlights theories for the increase in varicella zoster virus encephalitis cases causing neurologic symptoms and proposes that this trend is likely to continue.Mycobacterium chelonae can be difficult to treat because of inherent resistance to many available antimicrobials. We present a case of a multidrug-resistant M. chelonae skin infection in a 52-year-old woman who presented with a 3- to 4-week history of painful, erythematous nodules on the bilateral lower extremities. She demonstrated dramatic improvement at her 4-week follow-up on omadacycline.Kocuria kristinae is an aerobic gram-positive bacterium that is part of the normal skin flora and not a common cause of infection. Here, we present the first reported case of community-acquired pneumonia and bacteremia caused by K. kristinae.  https://www.selleckchem.com/products/Nolvadex.html  The pneumonia was complicated by acute on chronic diastolic heart failure, resulting in acute hypoxic respiratory failure requiring intubation and mechanical ventilation.Collapsing glomerulopathy is a distinct and aggressive clinicopathologic variant of focal segmental glomerulosclerosis (FSGS). Here we present a 46-year-old man with acute renal failure from biopsy-proven collapsing FSGS and nephrotic syndrome in the setting of a diagnosis of hemophagocytic lymphohistiocytosis secondary to acute Epstein-Barr virus infection. This rare association has not been well described previously.Langerhans cell histiocytosis (LCH), a disorder characterized by aberrant function and proliferation of mononuclear phagocytic cells called Langerhans cells, usually occurs in those less then 15 years of age. Adult-onset LCH is extremely rare. We present a case of a 35-year-old woman who presented with multiple episodes of confusion, rapidly progressive cognitive decline, and multiple endocrinopathies, including diabetes insipidus. Brain imaging showed a hypothalamic lesion, and biopsy results confirmed the diagnosis of LCH. Given the wide variety of presentations and the multiple differential diagnoses of hypothalamic lesions, it is essential to be aware of this uncommon condition, especially in adults, where it may be underdiagnosed.We present a rare case of severe ectopic Cushing's syndrome in a 39-year-old woman with a rapid onset of signs and symptoms and severe hypokalemia. Further workup demonstrated an adrenocorticotropic hormone-secreting metastatic high-grade neuroendocrine carcinoma.