Pasteurella multocida (P. multocida) is a gram-negative, facultative anaerobe, and it is most commonly found in the oropharynx of healthy domestic animals, especially cats and dogs. P. multocida is classified as an opportunistic pathogen, infecting individuals only through direct contact via local trauma caused by animal bites or scratches. More serious infections, while rare, are typically associated with immunocompromised states, known pre-existing cavitary lung pathology, or malignancy. In this report, we present a case of P. multocida infection without known trauma, which had likely spread via respiratory droplets causing bacteremia, septic shock, and subsequent septic arthritis of the left knee.

The reactivation of latent tuberculosis occurs when a patient living with Mycobacterium tuberculosis enters a state where the immune system is suppressed. Since early 2021, the standard of care has been to provide corticosteroids in patients with COVID-19 infection in hospitalized patients receiving supplemental oxygen or mechanical ventilation. The immunomodulatory effects of corticosteroids are potentially detrimental for patients with latent vs active tuberculosis, with concomitant SARS-CoV2 infection. We present one of the first few cases in the literature detailing a case of reactivation of latent tuberculosis vs. pleural tuberculosis as a consequence of COVID-19, and who underwent subsequent corticosteroid treatment.

Background: Thalassemia patients need regular blood transfusion which saves their lives but increases the risk of acquiring viral infections like hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Objective(s): This study aimed to screen out the HCV and HBV infections in Thalassemia patients receiving regular blood in three centers of Azad Jammu and Kashmir (AJK), Pakistan. Materials and Methods: It was a cross sectional, multicenter study involving 224 Thalassemia patients. The study was carried out from August 2019 to January 2020 in Thalassemia centers of Sheikh Khalifa Bin Zaid hospital Rawalakot, District Headquarters hospital (DHQ) Palandari, and Combined Military Hospital (CMH) Muzaffarabad, AJK. A total of 224 patients were screened out for HCV and HBV. Indirect ELISA was carried out to detect anti HCV antibodies while direct ELISA was carried out to detect the HBsAg from all the samples using commercially available ELISA kits. Results: Overall, 12 patients (5.36%) were found to be positive for HBV while 63 (28.1%) were positive for HCV. HBV positive patients included 7 (5.69%) males and 5 (4.95%) females while HCV positive patients included 26 (41.27%) males and 37 (58.73%) female patients. Both the viruses were more common among elder patients as compared to younger patients. Conclusion: Prevalence of HCV is very high and that of HBV is moderately high among Thalassemia patients of AJK.

Pulmonary vein thrombosis (PVT) is an uncommon but often lethal disease with non-specific manifestations. Herein, we present a case of an elderly woman with a past medical history significant for limited-stage pelvic myxofibrosarcoma (MFS), who was admitted with subacute weakness and worsening dyspnea. Over the course of hospitalization, CT angiography was performed, which demonstrated a filling defect in the inferior left pulmonary vein consistent with PVT, in addition to evidence of widespread metastatic disease. The patient was offered therapeutic anticoagulation, but given the extent of her metastasis, the patient opted to transition to comfort care and pursued hospice care. This case serves as a unique presentation of a rare disease process associated with widespread metastatic MFS, illustrating the need for early recognition and treatment.

Deployment of bare metal duodenal stents for individuals with gastric outlet obstructions (GOOs) is a wellcharacterized measure to improve the quality of life. However, these interventions are palliative in nature and are associated with known complications. We present an unfortunate case of a previously not well described, albeit not surprising, a complication of stent placement. The individual underwent duodenal stent placement due to obstructive metastatic disease and subsequently presented for gastrointestinal (GI) bleed. It was determined that an aortoduodenal fistula acutely developed and, despite heroic efforts, the patient ultimately expired.