Kern Medical Center

Abstract Background Coccidioidal meningitis (CM) is a form of disseminated coccidioidomycosis associated with significant morbidity and mortality. Based on clinician observations of increased numbers and complexity of CM hospitalizations at Kern Medical (KM), a community teaching hospital in Bakersfield, CA, we sought to characterize recent hospitalizations at KM for CM.Figure 1.KM Hospitalizations for CM from 2020-2024 Methods This Institutional Review Board-approved retrospective review included hospitalizations for CM at KM from January 1, 2020 to December 31, 2024. Hospital admissions with an International Classification of Diseases, tenth revision (ICD-10) code for CM (B38.4) were extracted from the electronic medical record, then manually reviewed to exclude admissions unrelated to CM management and gather additional demographics and outcomes data. Characteristics of interest for both the overall population and the subgroup of hospitalizations for a new CM diagnosis included length of stay (LOS), intensive care unit (ICU) admission, disposition, and trends over time. Results Across the 5-year time frame, 203 admissions (99 unique patients) were identified with ICD-10 code B38.4. Of these, 120 admissions (73 unique patients) were determined to be primarily for management of CM, with 28 admissions for new CM diagnoses. Mean hospitalizations per patient was 1.6 (range 1-6 admissions). Mean age at time of admission was 48 years, with men accounting for 84% of hospitalizations. Mean LOS was 10 days (range 1-80 days) with 5% in-hospital mortality. Admission to the ICU was required during 29% of encounters, including 12% with endotracheal intubations. Of the hospitalizations for a new CM diagnosis, mean LOS was 15 days (range 2-66 days) with 14% in-hospital mortality. ICU admission was required in 43% of new CM hospitalizations, with 25% requiring intubation. Trends in CM admissions over time are described in Figure 1. Conclusion CM is a devastating manifestation of coccidioidomycosis and this review highlights the burden of CM on clinical outcomes and healthcare resource utilization in an endemic setting. The apparent increase in hospitalizations for both new diagnoses and exacerbations of CM over a 5-year period is alarming and calls for further investigation to validate this trend and identify potential contributing factors. Disclosures All Authors: No reported disclosures

Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS). It is characterized by a triad of ataxia, areflexia, and ophthalmoparesis. Akin to GBS, it is often triggered by a respiratory infection, causing immune cross-activation against pathogenic proteins and gangliosides. Symptoms typically occur in chronological progression, beginning with ophthalmoparesis, then ataxia, and finally areflexia. Our case is of a patient presenting with dysphagia and ophthalmoplegia as the initial manifestations. There currently exist only a limited number of reported cases of MFS presenting with dysphagia, which, along with ophthalmoplegia, areflexia, and ataxia, should raise suspicion for MFS.

Intestinal malrotation is a rare congenital anomaly occurring in approximately 0.2% of live births that can lead to severe complications, including midgut volvulus, short bowel syndrome, and death. This study presents a unique case of an entirely right-sided colon with associated variations in vascular structures. Possible etiologies for this anatomical anomaly are discussed, along with its clinical implications.A detailed cadaveric dissection was performed on a donor patient at Western University of Health Sciences. The most interesting finding was that the entire colon was on the right side of the abdominal cavity, while the small intestine was on the left. The transverse colon was unusually short and constricted. The greater omentum lacked attachment to the transverse colon. The descending and sigmoid colon were supplied by the superior mesenteric artery instead of the inferior mesenteric artery. An abnormal artery branching from the inferior mesenteric artery supplied an intraperitoneal mass with the appearance of fatty tissue.Intestinal malrotation is frequently misdiagnosed, partly because patients tend to present with nonspecific abdominal symptoms. Although this patient’s exact medical history is unknown, the family reported generalized gastrointestinal issues, which could be accounted for by the intestinal configuration observed. This unusual case highlights the importance of studies on the prevalence, variations, and clinical consequences of malrotation to improve diagnostic and management strategies.

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy, most often diagnosed at an advanced stage, with limited treatment options and poor outcomes. CA 19-9 is the most commonly used biomarker to support the diagnosis and for treatment monitoring of PDAC, but rising levels during treatment usually suggest disease progression. Pseudoprogression, a transient increase in tumor burden or biomarker levels followed by subsequent improvement, has been described in glioblastoma and in cancers treated with immune checkpoint inhibitors (ICIs), but to our knowledge, it has not previously been reported in pancreatic cancer treated with cytotoxic chemotherapy.We describe a 52-year-old man with metastatic PDAC who was treated with FOLFOX due to underlying cardiac comorbidities. Despite rising CA 19-9 levels from 2,344 U/mL at baseline to more than 90,000 U/mL after two months of therapy, the patient experienced clinical improvement, with resolution of abdominal pain, regained appetite, weight recovery, and enhanced performance status. Continued treatment resulted in a subsequent decline and plateau of CA 19-9 levels, consistent with biochemical pseudoprogression. This case represents a unique and previously undocumented phenomenon of pseudoprogression in PDAC under chemotherapy, underscoring the importance of integrating clinical status with biomarker interpretation to avoid premature discontinuation of effective treatment.

Pulmonary sarcomatoid carcinoma is a rare non-small cell lung cancer that can rapidly progress and, unfortunately, serves as a diagnostic challenge. In many instances, patients can have non-specific symptoms, and the malignancy itself can produce negative biopsy results, leading to a false sense of security. This is especially true in larger tumors, since surrounding inflammation can obscure malignant tissue. As such, situations like these show the importance of a physician's clinical judgment in guiding management. Here, we would like to discuss a case where an asymptomatic 63-year-old man presented to the emergency department following a fall, but during the traumatic workup, an incidental lung mass was noted. Given the patient's lack of presenting hemoptysis, shortness of breath, unintentional weight loss, etc., with subsequent negative biopsy results, the patient was unconcerned regarding the pulmonary mass. Despite multiple attempts to contact the patient, he was lost to follow-up and returned with severe worsening of his malignancy. Thus, in this case report, we would like to discuss pulmonary sarcomatoid carcinoma, the methods of biopsy results, and the rate of false negatives, as well as highlight the importance of physicians' management and patient follow-up.

BackgroundSmall cell carcinoma (SCC) is a neuroendocrine tumor that usually originates in the lungs but can also arise from extrapulmonary sites. Extrapulmonary small cell carcinomas (EPSCCs) are aggressive and rare, with limited data guiding their management. This case report contributes to the literature by presenting the diagnosis and treatment of primary peritoneal SCC.Case presentationThis case describes a 69-year-old man who presented with abdominal distension and pain, raising concerns for metastasis. He had a history of prostate cancer treated with radical prostatectomy and pelvic lymph node dissection. Biopsy and imaging revealed metastatic SCC involving the peritoneum and omentum. A diagnosis of primary peritoneal SCC or SCC of unknown primary origin was made due to the absence of a detectable primary tumor in typical sites. The patient underwent three separate courses of carboplatin/etoposide chemotherapy (6 cycles each), with each course resulting in significant disease regression and symptom relief. Recurrence was managed effectively with repeated chemotherapy cycles, but long-term follow-up showed the need for continued treatment to maintain disease control and quality of life.ConclusionThis case underscores the importance of a multidisciplinary approach and patient-centered care in managing rare cancers like primary peritoneal SCC. Further research is essential to clarify its molecular characteristics and improve therapeutic options.Graphical abstractSupplementary InformationThe online version contains supplementary material available at 10.1007/s12672-025-03433-y.

Abstract Coccidioidomycosis, a fungal infection caused by coccidioides species, is endemic to regions with arid climates, such as the southwestern United States. This disease predominantly affects the respiratory system by may disseminate in immunocompromised individuals. Cancer patients, particularly those undergoing immunosuppressive therapies, are at heightened risk for opportunistic infections including coccidioidomycosis. This paper explores the complex interplay between coccidioidomycosis and cancer in an endemic area and the impact of co-occurrence on patient outcomes.

This case report details a rare and life-threatening complication of heat stroke: necrotizing pancreatitis. While heat stroke is known to affect multiple organ systems, its association with acute pancreatic necrosis is extremely uncommon and poses significant diagnostic and management challenges. In this report, we examine the patient’s clinical progression and discuss the possible underlying pathophysiological mechanisms linking heat stroke to necrotizing pancreatitis. We also highlight the multidisciplinary medical interventions undertaken, emphasizing the importance of early recognition and aggressive management in improving outcomes for patients with such severe complications.

BACKGROUND Pernicious anemia (PA) is caused by a deficiency in intrinsic factor (IF), which is necessary for vitamin B12 (cobalamin) absorption, resulting in vitamin B12 deficiency and subsequent megaloblastic anemia. Diagnosis of PA relies on the detection of circulating antibodies to IF. In addition to anemia, patients can develop neuropsychiatric conditions, such as subacute combined degeneration of the spinal cord or psychosis. We present the case of a patient with a history of schizophrenia who exhibited unusually severe manifestations of pernicious anemia, including life-threatening anemia, multiple hypersegmented neutrophils, and significantly elevated methylmalonic acid (MMA) levels. CASE REPORT A 51-year-old Hispanic woman with a history of schizophrenia was admitted with severe weakness, shortness of breath, and diarrhea. The hemoglobin (Hb) level was 2.5 g/dL and mean corpuscular volume (MCV) was 133 fL. A diagnosis of pernicious anemia was made by a low vitamin B12 level, high levels of methylmalonic acid (MMA) and homocysteine, and positive IF-blocking antibodies. Her anemia did not improve initially, even after 3 units of blood were transfused. She had no signs of bleeding. It was thought that hemoconcentration due to severe dehydration falsely raised her initial Hb levels, which were corrected by hydration. A peripheral blood smear showed many hypersegmented neutrophils. With parenteral cyanocobalamin therapy, her anemia and schizophrenia symptoms improved. The hypersegmented neutrophils disappeared by 2 weeks. CONCLUSIONS This is an extreme case of pernicious anemia with life-threatening anemia. The hypersegmented neutrophils disappeared in 2 weeks with vitamin B12 therapy. The symptoms of schizophrenia also improved.