We present a case of gonococcal septic arthritis of the right hip diagnosed via synovial fluid cultures. Antimicrobial susceptibility testing of the synovial fluid demonstrated susceptibility to tetracycline, ciprofloxacin, cefixime and ceftriaxone. Our patient was initially treated with ceftriaxone and was successfully de-escalated to oral levofloxacin to complete the treatment. This case is interesting given the rarity of disseminated gonococcal infections in the 21st century and that most clinical isolates of Neisseria gonorrhoeae are increasingly resistant to fluoroquinolones.

Ventriculitis is a rare intracranial disease with potentially life-threatening consequences. Here, we present a case of acute mastoiditis that progressed to Haemophilus influenzae meningitis evolving to ventriculitis. This case was complicated by hydrocephalus that subsequently required the placement of a ventriculoperitoneal shunt. In patients presenting with mastoiditis, it is imperative to initiate early and appropriate treatment to prevent disease progression and devastating outcomes. We aim to increase recognition of potential complications and encourage childhood vaccination of Haemophilus influenzae .

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Thrombotic storm is a rare hypercoagulable condition characterized by a clinical trigger causing extensive thrombotic events affecting multiple vessels over a short period of time. We present a case of thrombotic storm that developed in a patient who received rituximab therapy. The patient presented to the hospital with dyspnea and shortness of breath and was subsequently diagnosed with extensive thrombotic burden including multiple deep vein thrombi and pulmonary emboli. Hypercoagulable workup for the thrombotic storm was unrevealing with the only identifiable trigger being the rituximab infusion. The patient was treated successfully with anticoagulation and discontinuation of rituximab. There are very few reports highlighting thrombotic events as a complication of rituximab therapy. We aim to increase recognition of thrombotic storm as a potential complication of receiving rituximab therapy.

An elderly female presented to the emergency department with a right-sided facial droop and headache for two weeks. Investigations revealed poorly controlled diabetes, and the patient was found to be in diabetic ketoacidosis. Maxillofacial computed tomography (CT) demonstrated right postseptal cellulitis with concern for acute invasive fungal sinusitis. The patient was taken to the operating room for orbital surgical exploration and antrostomy. Surgical pathology revealed broad hyphae consistent with Rhizomucor species, and the patient was diagnosed with mucormycosis. Because the patient was not clinically improving, further imaging was obtained, which showed a large right retroantral phlegmon extending into the cranial fossa and right cavernous sinus, and the patient subsequently underwent surgical debridement. The following postoperative day, the patient was stroke-alerted due to altered mental status and inability to follow commands. She was found to have a small embolic infarct. Due to the poor prognosis of the patient, she was discharged with hospice. Mucormycosis is more commonly found in immunocompromised patients, such as those with uncontrolled diabetes mellitus but very rarely does it involve the cranium. This disease process is very important to recognize early due to high morbidity and mortality rates and devastating outcomes.