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The need for more research into chromogranins is proposed. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Minimal Change Disease (MCD) is identified via renal biopsy as the etiology of nephrotic syndrome in a minority of adult cases; however, a significant proportion of these occurrences are accompanied by acute kidney injury (AKI). Risk factors for AKI in MCD include increased age, male sex, hypertension, and marked proteinuria and hypoalbuminemia. The etiology of AKI appears to be tubular injury as demonstrated with biomarkers, and although it is usually reversible with steroid therapy, resistance and relapses can occur and may require the use of second-line agents. We present a case of an adult patient with acute onset of biopsy-proven MCD and AKI demonstrating a partial response to corticosteroids and aggressive diuresis and later relapsing and requiring further immunosuppression with tacrolimus. Ultimately, further studies are required to determine the optimal treatment regimen for MCD to ensure remission and avoid relapse. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Statins are widely prescribed medications to prevent cardiovascular events. While self-limited statin myopathy is relatively common, statin-induced necrotizing autoimmune myopathy (SINAM) is extremely uncommon, with incidence of two cases per million per year. We present a case of SINAM after a decade of atorvastatin use, leading to debilitating weakness. A 71-year-old male presented with recurrent falls due to extreme bilateral lower-extremity weakness without pain or sensory changes. No fever, chills, rash, joint pain, recent infection or medication changes were reported. Reported taking atorvastatin 80 mg daily for 10 years. Physical examination revealed significant muscle wasting on right deltoid and proximal muscle weakness in all extremities. Lab tests included elevated creatinine kinase, aldolase, ESR, CRP and transaminases. Anti-HMGCR antibody was significantly elevated. TSH, serum protein electrophoresis and RPR were unremarkable. ANA, Anti-Jo-1, anti-Mi2, anti-SRP, anti-ds-DNA, anti-SSA and anti-SSB antibodies were negative. MRI of thigh revealed diffuse myositis. Electromyogram revealed an acute myopathic process. Muscle biopsy showed muscle necrosis and C5b-9 sarcolemmal deposits on non-necrotic fibers without rimmed vacuoles. He was diagnosed with SINAM. Statin was discontinued, and steroid, immunoglobulins and azathioprine were started with gradual improvement. Unlike the self-limiting statin myopathy, SINAM is more severe and is associated with significant proximal muscle weakness, markedly elevated CK and persistent symptoms despite statin discontinuation. Anti-HMGCR antibodies are present in 100% of cases. Immunosuppressants are the mainstay of treatment, and statin rechallenge should never be done in these cases. Although relatively rare, physicians should be cognizant of SINAM. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.A 45-year-old Asian woman was presented with fever, easy fatigability, shortness of breath, cervical and axillary lymphadenopathy and other signs and symptoms of anemia. After all the baseline work-up, the patient was investigated for Mono-coombs C3d levels, which were elevated, suggesting the diagnosis of Cold autoimmune hemolytic anemia (Cold AIHA). An Ultrasound-guided true-cut biopsy was done to determine the primary cause associated with it, which showed the presence of tumor cells arranged in cords and clusters. They have dark staining cells with mitotic activity, suggestive of breast carcinoma as an association of Cold AIHA. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were sent, which came out to be positive. So, the patient was diagnosed with Cold AIHA in association with triple-positive breast cancer. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Infective endocarditis (IE) is a focus of infection which effects the endocardium, specifically the heart valves or intra-cardiac devices. A 64-year-old male with gastric carcinoma and no prior cardiac history presented to the emergency room with altered mental status. Initial investigations showed the patient had a leukocytosis with a left shift. Blood cultures taken upon arrival eventually grew Esherichia coli, thought to be from the urinary tract, although initial urinalysis was delayed until after initiation of antibiotics. Electrocardiogram showed sinus bradycardia with frequent premature atrial contractions. Chest X-Ray showed bilateral pleural effusions, which were eventually drained and found to be growing E. coli. Transthoracic echocardiogram was done which showed moderate-sized tricuspid valve vegetation with severe tricuspid regurgitation. IE has been increasing in incidence throughout the years. In prior decades IE was a disease primarily affecting patients with known rheumatic heart disease, prosthetic heart valves, and intravenous drug abusers however more commonly it is becoming healthcare acquired. E. coli is not often seen to be a culprit of IE. We present a rare case of E. coli endocarditis of a native tricuspid valve. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Background A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality. selleck kinase inhibitor Early diagnosis is imperative as thrombi are usually discovered after end organ damage has taken place. The formation of a mural thrombus in descending aorta has not been fully explained; however, the principle of Virchow's triad for thrombogenesis (hypercoagulability, stasis of blood flow and endothelial injury) remains the likely pathophysiologic mechanism. Case Presentation We present a case of a descending aortic thrombus incidentally detected on computed tomography scan in a 65-year-old female and successfully treated with anticoagulation, preventing subsequent complications. Conclusions Suspicion for an aortic thrombus should arise when the origin is not known for acute onset distal limb or organ ischemia. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.